Provider Demographics
NPI:1568661452
Name:AYYAR, SIVA (MD)
Entity Type:Individual
Prefix:MR
First Name:SIVA
Middle Name:
Last Name:AYYAR
Suffix:
Gender:M
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:PO BOX 700822
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95170
Mailing Address - Country:US
Mailing Address - Phone:832-308-1010
Mailing Address - Fax:832-308-1017
Practice Address - Street 1:6641 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021
Practice Address - Country:US
Practice Address - Phone:832-308-1010
Practice Address - Fax:832-308-1017
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA930062083X0100X
TXM25122083P0500X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine