Healthcare Provider Details

I. General information

NPI: 1356521843
Provider Name (Legal Business Name): VENKATA S.R. PULAKANTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E 4TH ST STE 122
SANTA ANA CA
92705-3912
US

IV. Provider business mailing address

241 DEBORAH CT
UPLAND CA
91784-1400
US

V. Phone/Fax

Practice location:
  • Phone: 909-496-1195
  • Fax:
Mailing address:
  • Phone: 909-496-1195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA51071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: