Provider Demographics
NPI:1225122120
Name:UDUPA, REKHA S (MBBS)
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:S
Last Name:UDUPA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 WATER LILY WAY STE 90
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2868
Mailing Address - Country:US
Mailing Address - Phone:408-252-1090
Mailing Address - Fax:408-252-1093
Practice Address - Street 1:1299 WATER LILY WAY STE 90
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2868
Practice Address - Country:US
Practice Address - Phone:408-252-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A680000Medicare PIN
CAH36739Medicare UPIN