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General NPI Number Information
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NPI Number | 1245772771
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Entity Type | Organization
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Legal Business Name | MEMORY PSYCHIATRIC SERVICES PC
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Dates
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Enumeration Date | 11/15/2016
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 4929 WILSHIRE BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90010-3808
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Country | US
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Telephone | 800-275-3243
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 WILSHIRE BLVD SUITE 510
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City | LOS ANGELES
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State | CA
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Zip | 90010-3808
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Country | US
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Telephone | 800-275-3243
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIKAS DUVVURI
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Credential | MD
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Telephone | 800-275-3243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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