Provider Demographics
NPI:1417754433
Name:VEDAMUTHU, MARGOSCHIS
Entity type:Individual
Prefix:
First Name:MARGOSCHIS
Middle Name:
Last Name:VEDAMUTHU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 BUNKHOUSE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555
Mailing Address - Country:US
Mailing Address - Phone:661-444-3991
Mailing Address - Fax:
Practice Address - Street 1:4941 BUNKHOUSE STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555
Practice Address - Country:US
Practice Address - Phone:661-330-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751125163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice