Provider Demographics
NPI:1184650871
Name:VETSA, SUREKHA SANTOSHKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUREKHA
Middle Name:SANTOSHKUMAR
Last Name:VETSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 SELO DR
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4411
Mailing Address - Country:US
Mailing Address - Phone:650-888-7556
Mailing Address - Fax:
Practice Address - Street 1:1351 SELO DR
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4411
Practice Address - Country:US
Practice Address - Phone:650-888-1917
Practice Address - Fax:408-733-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90010207P00000X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A900100OtherBLUE SHIELD OF CALIFORNIA
CA00A900100Medicaid
CA00A900103Medicare ID - Type UnspecifiedGERIATRIC PRACTICE
CA00A900102Medicare PIN
CAI26387Medicare UPIN