Basic Information
| Provider Information | |||||||||
| NPI: | 1518255942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VUTUKURI | ||||||||
| FirstName: | NAGA MALLESWARI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 VICTORIA LN STE 12 | ||||||||
| Address2: | |||||||||
| City: | HARLINGEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785503228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564406300 | ||||||||
| FaxNumber: | 8886983908 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 W FERTITTA BLVD | ||||||||
| Address2: | |||||||||
| City: | LEESVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714464645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372399041 | ||||||||
| FaxNumber: | 8886983908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2011 | ||||||||
| LastUpdateDate: | 10/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.207319 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.