Provider Demographics
NPI:1821462912
Name:J R VEMULAPALLI MD INC
Entity Type:Organization
Organization Name:J R VEMULAPALLI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAGANMOHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEMULAPALLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-344-7976
Mailing Address - Street 1:7036 SITIO FRONTERA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2045
Mailing Address - Country:US
Mailing Address - Phone:760-344-7976
Mailing Address - Fax:760-344-7106
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-344-7976
Practice Address - Fax:760-344-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty