Provider Demographics
NPI:1982654661
Name:VENKATESH, ALAGIRISWAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAGIRISWAMI
Middle Name:
Last Name:VENKATESH
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 1:4521 SHERMAN OAKS AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3807
Mailing Address - Country:US
Mailing Address - Phone:818-784-8442
Mailing Address - Fax:818-784-8642
Practice Address - Street 1:4521 SHERMAN OAKS AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3807
Practice Address - Country:US
Practice Address - Phone:818-784-8442
Practice Address - Fax:818-784-8642
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34195207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
W12121Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAA27410Medicare UPIN
CAWA34195EMedicare ID - Type UnspecifiedPPIN