=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508938358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INDIRA VEMURI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 04/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17705 HALE AVE STE I1
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-776-9560
-----------------------------------------------------
Fax | 408-778-7857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17705 HALE AVE STE: I-1
-----------------------------------------------------
City | MORGAN HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95037-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-776-9560
-----------------------------------------------------
Fax | 408-778-7857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | A80970
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------