MEDICARE: MARGOSCHIS VEDAMUTHU

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	163WG0000X	General Practice Registered Nurse	751125	CA
2	363LF0000X	Family Nurse Practitioner	95034607	CA

General Provider Information

NPI Number	:	1417754433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGOSCHIS VEDAMUTHU

Provider Business Mailing Address
First Line	:	4941 BUNKHOUSE ST
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555
Country	:	US
Telephone Number	:	661-444-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	4941 BUNKHOUSE STREET
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555
Country	:	US
Telephone Number	:	661-330-2772
Fax Number	:

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

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	05/05/2026

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Directions to “ MARGOSCHIS VEDAMUTHU ” Practice Location

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