Healthcare Provider Details

I. General information

NPI: 1710939822
Provider Name (Legal Business Name): A.VENKATESH,M.D.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 SHERMAN OAKS AVE SUITE 1 B
SHERMAN OAKS CA
91403-3807
US

IV. Provider business mailing address

4521 SHERMAN OAKS AVE SUITE 1 B
SHERMAN OAKS CA
91403-3807
US

V. Phone/Fax

Practice location:
  • Phone: 818-784-8442
  • Fax: 818-784-8642
Mailing address:
  • Phone: 818-784-8442
  • Fax: 818-784-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA34195
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA39371
License Number StateCA

VIII. Authorized Official

Name: DR. ALAGIRISWAMI VENKATESH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-784-8442