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General NPI Number Information
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NPI Number | 1912397688
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Entity Type | Organization
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Legal Business Name | PLEXUS ANESTHESIA MEDICAL
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 2675 STEVENSON BLVD 2ND FLOOR
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City | FREMONT
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State | CA
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Zip | 94538-2317
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Country | US
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Telephone | 510-791-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 43575 MISSION BLVD SUITE #341
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City | FREMONT
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State | CA
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Zip | 94539-5831
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Country | US
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Telephone | 510-497-4186
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Fax |
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Authorized Official
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Title or Position | PRESIDENT,
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Name | VIJAYALAKSHMI M REDDY
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Credential | MD
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Telephone | 510-497-4186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | A69268
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License Number State | CA
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