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General NPI Number Information
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NPI Number | 1639355944
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Entity Type | Individual
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Provider Name | ARUN VILLIVALAM M.D,
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Gender | Male
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Dates
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Enumeration Date | 01/16/2008
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 15195 NATIONAL AVE SUITE 205
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City | LOS GATOS
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State | CA
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Zip | 95032-2631
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Country | US
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Telephone | 408-502-6040
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Fax | 408-502-6040
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Provider Business Mailing Address
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Address Line | 15195 NATIONAL AVE SUITE 205
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City | LOS GATOS
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State | CA
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Zip | 95032-2631
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Country | US
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Telephone | 408-502-6040
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Fax | 408-502-6040
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A73520
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License Number State | CA
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