MEDICARE: MRITSA VENNELA KARUTURI

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1578434866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRITSA VENNELA KARUTURI

Provider Business Mailing Address
First Line	:	41550 ECLECTIC ST
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-1967
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 6TH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5209
Country	:	US
Telephone Number	:	760-299-5181
Fax Number	:

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

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	09/17/2025

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