Provider Demographics
NPI:1477637775
Name:PURI, VEENA (MD)
Entity type:Individual
Prefix:MRS
First Name:VEENA
Middle Name:
Last Name:PURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:VEENA
Other - Middle Name:
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 PURI CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4820
Mailing Address - Country:US
Mailing Address - Phone:925-484-3366
Mailing Address - Fax:925-484-3769
Practice Address - Street 1:2243 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1630
Practice Address - Country:US
Practice Address - Phone:510-797-7766
Practice Address - Fax:510-797-0595
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC03912Medicare UPIN