Healthcare Provider Details

I. General information

NPI: 1558114553
Provider Name (Legal Business Name): NAMRATA VUPPALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 24TH ST
RICHMOND CA
94804-1804
US

IV. Provider business mailing address

200 24TH ST
RICHMOND CA
94804-1804
US

V. Phone/Fax

Practice location:
  • Phone: 510-412-9200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: