Provider Demographics
NPI:1598114522
Name:VYAS, KRUTARTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRUTARTH
Middle Name:
Last Name:VYAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32358 FERNLEAF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2551
Mailing Address - Country:US
Mailing Address - Phone:909-336-8426
Mailing Address - Fax:
Practice Address - Street 1:36101 BOB HOPE DR
Practice Address - Street 2:SUITE B-2
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2001
Practice Address - Country:US
Practice Address - Phone:909-336-8426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health