Provider Demographics
NPI:1164874855
Name:MUKTHINUTHALAPATI, VIJAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:
Last Name:MUKTHINUTHALAPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:V V PAVAN KEDAR
Other - Middle Name:
Other - Last Name:MUKTHINUTHALAPATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DR STE 350
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1723
Practice Address - Country:US
Practice Address - Phone:831-430-7130
Practice Address - Fax:831-475-1187
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA184311207RG0100X
MA285017208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist