1821106329 NPI number — DR. NARAYANA VENKATA BULUSU M.D.

Table of content: DR. NARAYANA VENKATA BULUSU M.D. (NPI 1821106329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821106329 NPI number — DR. NARAYANA VENKATA BULUSU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULUSU
Provider First Name:
NARAYANA
Provider Middle Name:
VENKATA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821106329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20130 LAKE CHABOT RD
Provider Second Line Business Mailing Address:
SUITE /302
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-5340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-889-1700
Provider Business Mailing Address Fax Number:
510-889-7170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20055 LAKE CHABOT RD
Provider Second Line Business Practice Location Address:
SUITE /310
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-889-1700
Provider Business Practice Location Address Fax Number:
510-889-7170
Provider Enumeration Date:
08/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  A30679 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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