Individual
DR. GAYATHRI S VONTIVILLU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1901 N MACARTHUR BLVD, IRVING, TX 75061-2220
(972) 579-8485
(972) 579-3972
Mailing address
1901 N MACARTHUR BLVD, IRVING, TX 75061-2220
(972) 579-8485
(972) 579-3972
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301071781
MI
207R00000X
Internal Medicine Physician
Primary
N5463
TX
208M00000X
Hospitalist Physician
N5463
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217372601
—
TX
01
—
8CL601
BCBSTX
TX
Enumeration date
11/14/2005
Last updated
07/06/2012
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