Provider Demographics
NPI:1376202887
Name:VEENA S KATIKINENI MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VEENA S KATIKINENI MD INC A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:VEENA S KATIKINENI MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-351-3163
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA172714OtherCA LICENSE
CAFK8062919OtherDEA