Provider Demographics
NPI:1982798948
Name:TIRUVILUAMALA, PARVATHI (MD)
Entity Type:Individual
Prefix:
First Name:PARVATHI
Middle Name:
Last Name:TIRUVILUAMALA
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 1:14202 EDEN GRV
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2379
Mailing Address - Country:US
Mailing Address - Phone:619-417-4535
Mailing Address - Fax:858-866-0249
Practice Address - Street 1:5555 RESERVOIR DR
Practice Address - Street 2:201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5134
Practice Address - Country:US
Practice Address - Phone:858-866-0245
Practice Address - Fax:858-866-0249
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79302174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793020OtherMEDI-CAL
CAD06568Medicare UPIN
CAWA79302BMedicare PIN