Provider Demographics
NPI:1508938358
Name:VEMURI, INDIRA (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:VEMURI
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 1:17705 HALE AVE STE: I-1
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4348
Mailing Address - Country:US
Mailing Address - Phone:408-776-9560
Mailing Address - Fax:408-778-7857
Practice Address - Street 1:17705 HALE AVE STE I1
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4348
Practice Address - Country:US
Practice Address - Phone:408-776-9560
Practice Address - Fax:408-778-7857
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80970208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A809700Medicaid
00A809700Medicare ID - Type Unspecified
CA00A809700Medicaid