Healthcare Provider Details

I. General information

NPI: 1477711091
Provider Name (Legal Business Name): VINOD BALAKRISHNA RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 450
ORANGE CA
92868-4224
US

V. Phone/Fax

Practice location:
  • Phone: 714-984-6601
  • Fax:
Mailing address:
  • Phone: 714-509-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47298
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number47298
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberC169640
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC169640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: