Healthcare Provider Details

I. General information

NPI: 1437527348
Provider Name (Legal Business Name): SUSHMA INDUKURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE STE B
TRACY CA
95376-3454
US

IV. Provider business mailing address

530 W EATON AVE STE B
TRACY CA
95376-3454
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-9029
  • Fax: 209-834-5028
Mailing address:
  • Phone: 209-835-9029
  • Fax: 209-834-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number137942
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number137942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: