=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962754697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VCD ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2012
-----------------------------------------------------
Last Update Date | 10/04/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 PIONEER LN
-----------------------------------------------------
City | BISHOP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93514-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-873-3806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39709 DOVER DR
-----------------------------------------------------
City | PALMDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93551-3144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-873-3806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. VASUKI DARAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 760-873-3806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | A93866
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------