Provider Demographics
NPI:1114009552
Name:VINJAMURY, SIVARAMA PRASAD (LAC)
Entity Type:Individual
Prefix:MR
First Name:SIVARAMA
Middle Name:PRASAD
Last Name:VINJAMURY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 E AMBER VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604
Mailing Address - Country:US
Mailing Address - Phone:562-947-8755
Mailing Address - Fax:562-902-3332
Practice Address - Street 1:16200 E AMBER VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604
Practice Address - Country:US
Practice Address - Phone:562-943-7125
Practice Address - Fax:562-902-3398
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9458171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist