Provider Demographics
NPI:1104372499
Name:INDUKURI, VENKATA SIDDARDHA VARMA
Entity Type:Individual
Prefix:MR
First Name:VENKATA
Middle Name:SIDDARDHA VARMA
Last Name:INDUKURI
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 1:1885 LUNDY AVE
Mailing Address - Street 2:223
Mailing Address - City:SANJOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1887
Mailing Address - Country:US
Mailing Address - Phone:408-503-7960
Mailing Address - Fax:
Practice Address - Street 1:1885 LUNDY AVE
Practice Address - Street 2:223
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1887
Practice Address - Country:US
Practice Address - Phone:408-503-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health