Healthcare Provider Details

I. General information

NPI: 1982224788
Provider Name (Legal Business Name): VAKKALANKA MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13622 BEAR VALLEY RD # 9
VICTORVILLE CA
92392-8509
US

IV. Provider business mailing address

13622 BEAR VALLEY RD # 9
VICTORVILLE CA
92392-8509
US

V. Phone/Fax

Practice location:
  • Phone: 760-261-4255
  • Fax: 442-327-9507
Mailing address:
  • Phone: 760-261-4255
  • Fax: 442-327-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN OPARA
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-908-0371