Provider Demographics
NPI:1093595241
Name:VALLURU, WILSON BABU
Entity Type:Individual
Prefix:
First Name:WILSON BABU
Middle Name:
Last Name:VALLURU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 S WHEELING AVE APT 35P
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8627
Mailing Address - Country:US
Mailing Address - Phone:539-292-5559
Mailing Address - Fax:
Practice Address - Street 1:7821 S WHEELING AVE APT 35P
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8627
Practice Address - Country:US
Practice Address - Phone:539-292-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2024-04-03
Deactivation Date:2024-03-27
Deactivation Code:
Reactivation Date:2024-04-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator