Provider Demographics
NPI:1992870026
Name:REKHA UDUPA M D INC
Entity type:Organization
Organization Name:REKHA UDUPA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:UDUPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-252-1090
Mailing Address - Street 1:1299 WATER LILY WAY STE 90
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-2868
Mailing Address - Country:US
Mailing Address - Phone:408-252-1090
Mailing Address - Fax:408-252-1093
Practice Address - Street 1:1299 WATER LILY WAY STE 90
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-2868
Practice Address - Country:US
Practice Address - Phone:408-252-1090
Practice Address - Fax:408-252-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty