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General NPI Number Information
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NPI Number | 1184646143
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Entity Type | Individual
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Provider Name | DASARATHA VEMIREDDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 916 I ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4313
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Country | US
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Telephone | 209-826-0477
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Fax | 209-826-0686
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Provider Business Mailing Address
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Address Line | 916 I STREET
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City | LOS BANOS
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State | CA
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Zip | 93635-3459
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Country | US
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Telephone | 209-826-0477
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Fax | 209-826-0686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A32138
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License Number State | CA
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