Healthcare Provider Details

I. General information

NPI: 1598345043
Provider Name (Legal Business Name): VEDANTI YOGESH UPADHYAYA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 N IH 35
LIVE OAK TX
78233-2609
US

IV. Provider business mailing address

12702 N IH 35
LIVE OAK TX
78233-2609
US

V. Phone/Fax

Practice location:
  • Phone: 210-650-9660
  • Fax: 210-654-1432
Mailing address:
  • Phone: 210-650-9660
  • Fax: 210-654-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV2308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: