Provider Demographics
NPI:1255470480
Name:DUVVURI, VIKAS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:
Last Name:DUVVURI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-464-1165
Mailing Address - Fax:619-567-1011
Practice Address - Street 1:1941 OFARRELL ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1340
Practice Address - Country:US
Practice Address - Phone:650-425-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA997062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry