Provider Demographics
NPI:1265722102
Name:MUKKU, ROY BHARATH (MD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:BHARATH
Last Name:MUKKU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 S BUENA VISTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4570
Mailing Address - Country:US
Mailing Address - Phone:818-848-6404
Mailing Address - Fax:818-848-7112
Practice Address - Street 1:201 S BUENA VISTA ST STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4570
Practice Address - Country:US
Practice Address - Phone:818-848-6404
Practice Address - Fax:818-848-7112
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY268278207R00000X
CA136888207R00000X
CAA136888207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine