IndividualActive
Jeremy Vandehurst, L-AT
NPI 1861027625 · Sports Medicine (Emergency Medicine) Physician · South Lake Tahoe, CA
Provider details
- NPI number
- 1861027625
- Entity type
- Individual
- Primary specialty
- Sports Medicine (Emergency Medicine) PhysicianAllopathic & Osteopathic Physicians
- Credential
- L-AT
- Sex
- Male
- Sole proprietor
- Yes
- License
- 0506428 (NV)
Practice location
2170 South Ave # B
South Lake Tahoe, CA 96150-7008
Phone: (530) 208-8253
Mailing address
2795 Springwood Dr
South Lake Tahoe, CA 96150-2815
Registry dates
- Enumerated
- 2020-03-11
- Last updated
- 2020-03-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.