Healthcare Provider Details

I. General information

NPI: 1861021644
Provider Name (Legal Business Name): BHAVYA VENIGALLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD # SB-290
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5841
  • Fax:
Mailing address:
  • Phone: 319-356-2633
  • Fax: 319-356-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-54889
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA206018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: