Basic Information
| Provider Information | |||||||||
| NPI: | 1467956268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MISHRA | ||||||||
| FirstName: | VIVECA | ||||||||
| MiddleName: | KRIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VALSARAJ | ||||||||
| OtherFirstName: | VIVECA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 313 E 12TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123249650 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 313 E 12TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787011955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123249650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2018 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | T3825 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.