Healthcare Provider Details

I. General information

NPI: 1831355320
Provider Name (Legal Business Name): NIVEDITHA VILASAGAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEETHA VILASAGAR M.D.

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W DUARTE RD STE 302
ARCADIA CA
91007-9278
US

IV. Provider business mailing address

244 MADISON AVE STE 141
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 858-295-0501
  • Fax: 308-646-6140
Mailing address:
  • Phone: 669-201-0667
  • Fax: 818-616-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA110069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: