Individual
MR. VACHASPATHI PALAKODETI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
516 WEST ATEN ROAD, SUITE 1, IMPERIAL, CA 92251
(760) 355-8300
(760) 545-0240
Mailing address
516 WEST ATEN ROAD, SUITE 2, IMPERIAL, CA 92251
(760) 355-7730
(760) 355-7731
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A52484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A524840
—
CA
01
—
GR0066313
MEDI CAL GROUP NUMBER
CA
01
—
WA52484J
MEDICARE PTAN
CA
01
—
ZZZ54781Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
05/19/2006
Last updated
12/19/2016
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