Individual
LATHA SREE VELLANKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6648 E CARONDELET DR, TUCSON, AZ 85710-2119
(520) 886-8151
Mailing address
7300 RANCH ROAD 2222, BUILDING 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 233-2711
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
75825
AZ
207N00000X
Dermatology Physician
8071
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092195
BLUE CROSS BLUE SHIELD
MT
05
—
0052700
—
MT
01
—
070017373
RAILROAD MEDICARE
MT
Enumeration date
09/28/2006
Last updated
02/12/2025
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