Healthcare Provider Details

I. General information

NPI: 1407212640
Provider Name (Legal Business Name): NORTHERN NEVADA PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NORTH MINNESOTA STREET
CARSON CITY NV
89702
US

IV. Provider business mailing address

PO BOX 1811
CARSON CITY NV
89702-1811
US

V. Phone/Fax

Practice location:
  • Phone: 775-291-8889
  • Fax: 775-964-4814
Mailing address:
  • Phone: 775-291-8889
  • Fax: 775-964-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10804
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number10804
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number10804
License Number StateNV

VIII. Authorized Official

Name: DWARAKANATH VUPPALAPATI
Title or Position: OWNER
Credential: M.D.
Phone: 775-291-8889