Provider Demographics
NPI:1801820857
Name:BHARATHI S VAYUVEGULA MD PHD INC
Entity Type:Organization
Organization Name:BHARATHI S VAYUVEGULA MD PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARATHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAYUVEGULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-914-0174
Mailing Address - Street 1:1624 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5433
Mailing Address - Country:US
Mailing Address - Phone:626-914-0174
Mailing Address - Fax:626-914-2008
Practice Address - Street 1:1624 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5433
Practice Address - Country:US
Practice Address - Phone:626-914-0174
Practice Address - Fax:626-914-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21346Medicaid