Healthcare Provider Details

I. General information

NPI: 1215794284
Provider Name (Legal Business Name): JAGGU HEALTHCARE & INNOVATIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 OLD GALLOWS RD STE 210
VIENNA VA
22182-3931
US

IV. Provider business mailing address

1945 OLD GALLOWS RD STE 210
VIENNA VA
22182-3931
US

V. Phone/Fax

Practice location:
  • Phone: 571-470-6243
  • Fax: 571-200-2617
Mailing address:
  • Phone: 571-470-6243
  • Fax: 571-200-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIJAYENDRA RAO JALIGAM
Title or Position: CEO
Credential: MD
Phone: 504-289-3788