Healthcare Provider Details

I. General information

NPI: 1356561930
Provider Name (Legal Business Name): DEEPA RAMACHANDRAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3162 NEWBERRY DR STE 30
SAN JOSE CA
95118-1567
US

IV. Provider business mailing address

3162 NEWBERRY DR STE 30
SAN JOSE CA
95118-1567
US

V. Phone/Fax

Practice location:
  • Phone: 408-335-7640
  • Fax: 408-351-8999
Mailing address:
  • Phone: 408-335-7640
  • Fax: 408-351-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: