Basic Information
| Provider Information | |||||||||
| NPI: | 1376750059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VEMIREDDY | ||||||||
| FirstName: | ROOPA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 VETERANS BLVD | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940632037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502992000 | ||||||||
| FaxNumber: | 7027598779 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 VETERANS BLVD | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940632037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502992000 | ||||||||
| FaxNumber: | 7023841815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 30351 | OK | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | A120478 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 15042 | NV | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P01292451 | 01 | CA | RR MEDICARE DR | OTHER | 1376750059 | 05 | CA | MEDICAID | P01285917 | 01 | CA | RR MEDICARE DRS | OTHER |