Provider Demographics
NPI:1740256460
Name:MARUPURU, SOUJANYA (MD)
Entity type:Individual
Prefix:
First Name:SOUJANYA
Middle Name:
Last Name:MARUPURU
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 1:490 S FARRELL DR STE C106
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7962
Mailing Address - Country:US
Mailing Address - Phone:760-416-6773
Mailing Address - Fax:866-519-7551
Practice Address - Street 1:490 S FARRELL DR STE C106
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7962
Practice Address - Country:US
Practice Address - Phone:760-416-6773
Practice Address - Fax:866-519-7551
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104873207Q00000X
KS6100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103828OtherBLUE CROSS/BLUE SHIELD
KS103828OtherBLUE CROSS/BLUE SHIELD
KSI13317Medicare UPIN