Basic Information
| Provider Information | |||||||||
| NPI: | 1821462912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | J R VEMULAPALLI MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7036 SITIO FRONTERA | ||||||||
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| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920092045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603447976 | ||||||||
| FaxNumber: | 7603447106 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 W LEGION RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BRAWLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922277732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603447976 | ||||||||
| FaxNumber: | 7603447106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2015 | ||||||||
| LastUpdateDate: | 12/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | VEMULAPALLI | ||||||||
| AuthorizedOfficialFirstName: | JAGANMOHAN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7603447976 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.