Provider Demographics
NPI:1790769578
Name:PARUCHURI, VIJAYASREE (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIJAYASREE
Middle Name:
Last Name:PARUCHURI
Suffix:
Gender:F
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 640
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0640
Mailing Address - Country:US
Mailing Address - Phone:714-269-5755
Mailing Address - Fax:714-763-4374
Practice Address - Street 1:19055 GREEN OAKS RD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2750
Practice Address - Country:US
Practice Address - Phone:714-269-5755
Practice Address - Fax:714-763-4374
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69396207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69396Medicare ID - Type Unspecified