Healthcare Provider Details

I. General information

NPI: 1164874855
Provider Name (Legal Business Name): VIJAYA MUKTHINUTHALAPATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: V V PAVAN KEDAR MUKTHINUTHALAPATI MD

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 DOMINICAN WAY STE 210
SANTA CRUZ CA
95065-1556
US

IV. Provider business mailing address

416B MAIN ST
SALINAS CA
93901-3306
US

V. Phone/Fax

Practice location:
  • Phone: 831-260-3591
  • Fax: 800-785-5318
Mailing address:
  • Phone: 831-800-7887
  • Fax: 831-998-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA184311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: