Healthcare Provider Details

I. General information

NPI: 1356374029
Provider Name (Legal Business Name): HEMALATHA VANGALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 VETERANS MEMORIAL CIR STE B
YUBA CITY CA
95993-3011
US

IV. Provider business mailing address

1445 VETERANS MEMORIAL CIR STE B
YUBA CITY CA
95993-3011
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7240
  • Fax: 530-822-7102
Mailing address:
  • Phone: 530-822-7240
  • Fax: 530-822-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA78672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: