Healthcare Provider Details

I. General information

NPI: 1053473934
Provider Name (Legal Business Name): HYMAVATHI VELKURU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W HUNTINGTON DR SUITE #327
ARCADIA CA
91007-3462
US

IV. Provider business mailing address

301 W HUNTINGTON DR SUITE #327
ARCADIA CA
91007-3462
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-8138
  • Fax: 626-447-2094
Mailing address:
  • Phone: 626-447-8138
  • Fax: 626-447-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: