Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A73424 | CA |
NPI | 1023044476 |
---|---|
Provider Name | Mrs. Bharathi S Vayuvegula |
First Address | Glendora, CA 91740-5433 |
Second Address | Glendora, CA 91740-5433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A7324 | (05) | CA |