Tarathya Bunga Dharmasaputra, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A195428 Issued in CA

Practice address

15237 Eleventh St Ste a
Victorville, CA 92395-3736

Phone

(760) 662-7420

Fax

(760) 513-9000

NPI assigned

Jul 13, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Golden State Primary Care Inc

  • General Practice Physician
  • Fontana, CA
  • NPI 1124987201

  Pediatrics

  NPD (past)
• Victorville Pediatrics

  • Pediatrics Physician
  • Victorville, CA
  • NPI 1497249155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1093387672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15237 ELEVENTH ST STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953736",
            "telephone_number": "760-662-7420",
            "fax_number": "718-963-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15237 ELEVENTH ST STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953736",
            "telephone_number": "760-662-7420",
            "fax_number": "760-513-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "760 Broadway Dept Of",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112065317",
            "country_code": "US",
            "telephone_number": "718-963-7956",
            "fax_number": "718-963-7957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DHARMASAPUTRA",
        "first_name": "TARATHYA",
        "middle_name": "BUNGA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-13",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A195428",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Deveze
• Deandra Devine
• Aditya Devineni, MD, MS
• Venkat Devineni, MD
• Renae Devolld
• Diamond Pathology LLC
• Amy Diaz
• Audria Diaz
• Evelyn Yvette Diaz, LVN
• Gustavo Diaz Jr.

• Pediatrics Physician in Victorville, CA
• Providers in Victorville, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.