Vetzrel Adidala, PA-C
Individual provider Active NPI Physician Assistant · Stanford, CA
NPI 1134964372 · NPPES record last updated Nov 11, 2024
Key facts
- NPI
- 1134964372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 64851 (CA)
- Practice address
- 300 Pasteur Dr
Stanford, CA 94305-2200 - Phone
- (650) 723-4000
- NPI assigned
- Jun 28, 2024
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250320000778 | CA | Practitioner - Physician Assistant | 5698297562 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64851 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Permanente Medical Group, Inc | Current |
Accepting new patients | |
| Permanente Medical Group Inc | Current |
Accepting new patients | |
| Stanford Health Care | Past | Accepting new patients |
Locations
710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 64851 | CA | Yes |
Addresses
Primary practice location
300 Pasteur Dr
Stanford, CA 94305-2200
Mailing address
300 Pasteur Dr
Stanford, CA 94305-2200
Phone (650) 723-4000
Other providers in Stanford, CA
- Dennis Wayne Adams Jr.
- Karen Elaine Adams
- Madeline Elizabeth Adams
- Michelle Yu Adams
- Rishav Raj Adhikari
- Shaunak Sanjay Adkar
- John R Adler Jr.
- Sarah Adler
- Shelby Mae Adler
- Shehla Admani
All providers in Stanford, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.