Provider Demographics
NPI:1659408896
Name:VUDDAGIRI, LAVANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVANYA
Middle Name:
Last Name:VUDDAGIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAVANYA
Other - Middle Name:
Other - Last Name:KALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS
Mailing Address - Street 1:2020 PALOMINO LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4812
Mailing Address - Country:US
Mailing Address - Phone:702-759-8600
Mailing Address - Fax:702-384-7075
Practice Address - Street 1:2020 PALOMINO LN
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4812
Practice Address - Country:US
Practice Address - Phone:702-759-8600
Practice Address - Fax:702-384-7075
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA989452085R0202X
NV126972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology