Provider Demographics
NPI:1699877480
Name:DEPALA, VENUGOPAL (MD)
Entity type:Individual
Prefix:
First Name:VENUGOPAL
Middle Name:
Last Name:DEPALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892998
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-2998
Mailing Address - Country:US
Mailing Address - Phone:951-737-5787
Mailing Address - Fax:951-296-3585
Practice Address - Street 1:27349 JEFFERSON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5634
Practice Address - Country:US
Practice Address - Phone:951-737-5787
Practice Address - Fax:951-296-3585
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC526482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C526480OtherMEDICARE PTAN
CAI17487Medicare PIN
CA00C526480OtherMEDICARE PTAN
I17487Medicare ID - Type Unspecified