MEDICARE: DR. VITHYA SAIRAM M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A123237	CA
2	2083X0100X	Occupational Medicine Physician	A123237	CA

General Provider Information

NPI Number	:	1043472210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VITHYA SAIRAM M.D

Provider Business Mailing Address
First Line	:	10726 OCEAN HEIGHTS WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4346
Country	:	US
Telephone Number	:	774-253-5508
Fax Number	:	774-253-5508

Provider Business Practice Location Address
First Line	:	5575 RUFFIN RD STE 100
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1361
Country	:	US
Telephone Number	:	774-253-5508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	07/30/2024

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