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General NPI Number Information
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NPI Number | 1700498722
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Entity Type | Individual
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Provider Name | SRAVANA JYOTHI VELLATURI
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Gender | Female
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 780 1ST ST
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City | GILROY
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State | CA
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Zip | 95020-4972
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Country | US
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Telephone | 408-796-3110
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Fax |
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Provider Business Mailing Address
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Address Line | 39224 GUARDINO DR APT 113
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City | FREMONT
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State | CA
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Zip | 94538-3018
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Country | US
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Telephone | 270-792-6395
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 105241
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License Number State | CA
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