Healthcare Provider Details

I. General information

NPI: 1871170142
Provider Name (Legal Business Name): ARAVIND ADDEPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EAST 31ST STREET, QIC 22123
OAKLAND CA
94602
US

IV. Provider business mailing address

1411 EAST 31ST STREET, QIC 22123
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4564
  • Fax:
Mailing address:
  • Phone: 510-437-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA194682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: