Individual
DR. KANTI SRI VITTALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 S DOBSON RD, MESA, AZ 85202-4707
(480) 412-5437
Mailing address
1790 S VILLAS LN, CHANDLER, AZ 85286-8416
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
50690
AZ
208000000X
Pediatrics Physician
A128129
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/13/2011
Last updated
01/02/2019
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