Provider Demographics
NPI:1679685796
Name:YELAMANCHILI, RAJEEV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJEEV
Middle Name:
Last Name:YELAMANCHILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16017 TUSCOLA RD STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1317
Mailing Address - Country:US
Mailing Address - Phone:760-242-2221
Mailing Address - Fax:760-242-1249
Practice Address - Street 1:16017 TUSCOLA RD STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1317
Practice Address - Country:US
Practice Address - Phone:760-242-2221
Practice Address - Fax:760-242-1249
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A381900207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC0076470Medicare UPIN