Healthcare Provider Details

I. General information

NPI: 1245263664
Provider Name (Legal Business Name): VINOD K VALIVETI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 E WILBUR RD STE 101
THOUSAND OAKS CA
91360-7925
US

IV. Provider business mailing address

PO BOX 5062
OXNARD CA
93031-5062
US

V. Phone/Fax

Practice location:
  • Phone: 805-278-0720
  • Fax: 805-988-4482
Mailing address:
  • Phone: 805-278-0720
  • Fax: 805-988-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA73845
License Number StateCA

VIII. Authorized Official

Name: VINOD K VALIVETI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-278-0720