Provider Demographics
NPI: | 1710946363 |
---|---|
Name: | VEMPATI, SUNITA (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | SUNITA |
Middle Name: | |
Last Name: | VEMPATI |
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: | PO BOX 10076 |
Mailing Address - Street 2: | |
Mailing Address - City: | VAN NUYS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91410-0076 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 805-578-8300 |
Mailing Address - Fax: | 805-578-8950 |
Practice Address - Street 1: | 438 W LAS TUNAS DR |
Practice Address - Street 2: | |
Practice Address - City: | SAN GABRIEL |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91776-1216 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-570-6597 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-22 |
Last Update Date: | 2009-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | A72533 | 207ZC0500X, 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 00A725330 | Medicaid | |
CA | H93178 | Medicare UPIN | |
CA | WA72533C | Medicare ID - Type Unspecified | PPIN |