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General NPI Number Information
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NPI Number | 1174090021
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Entity Type | Organization
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Legal Business Name | DR MARUPURU A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 490 S FARRELL DR STE C106
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City | PALM SPRINGS
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State | CA
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Zip | 92262-7962
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Country | US
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Telephone | 760-416-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 73622 VERMEER WAY
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City | PALM DESERT
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State | CA
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Zip | 92211-4542
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Country | US
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Telephone | 785-418-0314
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SOUJANYA MARUPURU
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Credential |
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Telephone | 316-841-6306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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