Provider Demographics
NPI:1346770971
Name:KATIKINENI, VEENA SUVARNA (MD)
Entity Type:Individual
Prefix:
First Name:VEENA
Middle Name:SUVARNA
Last Name:KATIKINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12677 HESPERIA RD STE 140
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7735
Mailing Address - Country:US
Mailing Address - Phone:442-242-7334
Mailing Address - Fax:442-242-7372
Practice Address - Street 1:12677 HESPERIA RD STE 140
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7735
Practice Address - Country:US
Practice Address - Phone:442-242-7334
Practice Address - Fax:442-242-7372
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT218370207RR0500X
VA0116030737390200000X
CAA172714207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA172714OtherMEDICAL LICENSE
CAA172714OtherMEDICAL LICENSE