Healthcare Provider Details

I. General information

NPI: 1043771413
Provider Name (Legal Business Name): VIVEK RAM VALLURUPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR PO BOX 6100
NEWPORT BEACH CA
92658-6100
US

IV. Provider business mailing address

1 HOAG DR PO BOX 6100
NEWPORT BEACH CA
92658-6100
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-6954
  • Fax: 949-764-5674
Mailing address:
  • Phone: 949-764-6954
  • Fax: 949-764-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA182469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: