Healthcare Provider Details

I. General information

NPI: 1407806086
Provider Name (Legal Business Name): GEETHA BHUSHAPPAGALA THIPPESWAMY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE PEDIATRICS DEPARTMENT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

100 BUCKINGHAM DR APT 165
SANTA CLARA CA
95051-7100
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax:
Mailing address:
  • Phone: 408-717-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: