Healthcare Provider Details

I. General information

NPI: 1003902081
Provider Name (Legal Business Name): RAO VENKATESWARA DALUVOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15982 QUANTICO RD STE D
APPLE VALLEY CA
92307-1382
US

IV. Provider business mailing address

15982 QUANTICO RD STE D
APPLE VALLEY CA
92307-1382
US

V. Phone/Fax

Practice location:
  • Phone: 760-810-0920
  • Fax: 760-515-6044
Mailing address:
  • Phone: 760-810-0920
  • Fax: 760-515-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA32269
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA32269
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberA32269
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA32269
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA32269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: