Individual
JYOTHI ISWARYA TIRUMALASETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 723-4000
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
C164641
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621679
BCBS GROUP #
IL
01
—
036111350
STATE LICENSE
IL
01
—
336072525
CCS
IL
01
—
C164641
STATE LICENSE
CA
Enumeration date
05/28/2006
Last updated
04/17/2024
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