Provider Demographics
NPI:1407997737
Name:PARVATHI TIRUVILUAMALA M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PARVATHI TIRUVILUAMALA M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRUVILUAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-417-4535
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-0628
Mailing Address - Country:US
Mailing Address - Phone:619-417-4535
Mailing Address - Fax:619-286-2344
Practice Address - Street 1:5555 RESERVOIR DR
Practice Address - Street 2:201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5134
Practice Address - Country:US
Practice Address - Phone:619-286-8804
Practice Address - Fax:619-286-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793020OtherMEDI-CAL
CAD06568Medicare UPIN
CAW18169Medicare PIN