Provider Demographics
NPI:1245263664
Name:VINOD K. VALIVETI M.D. INC.,
Entity type:Organization
Organization Name:VINOD K. VALIVETI M.D. INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:K
Authorized Official - Last Name:VALIVETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-278-0720
Mailing Address - Street 1:PO BOX 5062
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-5062
Mailing Address - Country:US
Mailing Address - Phone:805-278-0720
Mailing Address - Fax:805-988-4482
Practice Address - Street 1:1901 OUTLET CENTER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0663
Practice Address - Country:US
Practice Address - Phone:805-278-0720
Practice Address - Fax:805-988-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73845207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73845Medicare ID - Type Unspecified
CAH02729Medicare UPIN