Individual
DR. VIJAYALAXMI BOGAVELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9155 SW BARNES RD, STE 333, PORTLAND, OR 97225-6625
(503) 216-5102
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD166266
OR
2084P0804X
Child & Adolescent Psychiatry Physician
95-01178
NC
2084P0804X
Child & Adolescent Psychiatry Physician
MD166266
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500686948
—
OR
05
—
5901479
—
NC
Enumeration date
12/11/2006
Last updated
02/15/2021
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