Healthcare Provider Details

I. General information

NPI: 1912493107
Provider Name (Legal Business Name): TULASI DEEPTHI KARRI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 160
ORANGE CA
92868-4500
US

IV. Provider business mailing address

505 S MAIN ST STE 160
ORANGE CA
92868-4500
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-3444
  • Fax: 714-509-3477
Mailing address:
  • Phone: 714-509-3444
  • Fax: 714-509-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301115516
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301504070
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: