Provider Demographics
NPI:1659330850
Name:MYLAVARAPU, SUBBARAO V (MD)
Entity Type:Individual
Prefix:
First Name:SUBBARAO
Middle Name:V
Last Name:MYLAVARAPU
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 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-722-2411
Mailing Address - Fax:949-650-4966
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 610
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-722-2411
Practice Address - Fax:949-650-4966
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044935207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA44935NMedicare ID - Type UnspecifiedINDIVIDUAL ID
CAA61318Medicare UPIN
CAW15671Medicare PIN