Provider Demographics
NPI:1184646143
Name:VEMIREDDY, DASARATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:DASARATHA
Middle Name:
Last Name:VEMIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DASARATHA
Other - Middle Name:R
Other - Last Name:VEMIREDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:916 I STREET
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3459
Mailing Address - Country:US
Mailing Address - Phone:209-826-0477
Mailing Address - Fax:209-826-0686
Practice Address - Street 1:916 I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4313
Practice Address - Country:US
Practice Address - Phone:209-826-0477
Practice Address - Fax:209-826-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32138261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87608Medicare UPIN