Provider Demographics
NPI:1639355944
Name:VILLIVALAM, ARUN (MD,)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:
Last Name:VILLIVALAM
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 1:15195 NATIONAL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2631
Mailing Address - Country:US
Mailing Address - Phone:408-502-6040
Mailing Address - Fax:408-502-6040
Practice Address - Street 1:15195 NATIONAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2631
Practice Address - Country:US
Practice Address - Phone:408-502-6040
Practice Address - Fax:408-502-6040
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine