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General NPI Number Information
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NPI Number | 1225218522
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Entity Type | Individual
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Provider Name | VIJAYA K. KATUKOTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 975 SAINT JOHN PL STE A
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City | HEMET
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State | CA
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Zip | 92543-4428
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Country | US
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Telephone | 323-550-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 4295 JURUPA ST STE 117
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City | ONTARIO
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State | CA
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Zip | 91761-1430
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Country | US
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Telephone | 323-550-1920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A38220
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License Number State | CA
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