Provider Demographics
NPI:1174090021
Name:DR MARUPURU A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR MARUPURU A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOUJANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARUPURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-841-6306
Mailing Address - Street 1:73622 VERMEER WAY
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-4542
Mailing Address - Country:US
Mailing Address - Phone:785-418-0314
Mailing Address - Fax:
Practice Address - Street 1:490 S FARRELL DR STE C106
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7962
Practice Address - Country:US
Practice Address - Phone:760-416-6773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty