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General NPI Number Information
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NPI Number | 1619132495
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Entity Type | Individual
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Provider Name | SANDEEP VETTETH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2008
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 505 NE 87TH AVE SUITE 460
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City | VANCOUVER
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State | WA
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Zip | 98664-1989
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Country | US
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Telephone | 360-514-2470
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Fax | 360-514-7624
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Provider Business Mailing Address
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Address Line | 1115 SE 164TH AVE DEPT 358
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City | VANCOUVER
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State | WA
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Zip | 98683-8004
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Country | US
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Telephone |
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Fax |
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD60594991
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License Number State | WA
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