Individual provider Active NPI

Vivek Ratnakar Ullal, M.D.

  • Anesthesiology Physician
  • Simi Valley, CA
National Provider Identifier
1235143306
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A34774 Issued in CA
Practice address
2975 Sycamore Dr
Simi Valley, CA 93065-1201
Phone
(805) 955-6900
Fax
(805) 955-6063
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A34774 CA Primary

Addresses

Primary practice location

2975 Sycamore Dr
Simi Valley, CA 93065-1201

Mailing address

101 S 1St St
1000
Burbank, CA 91502-1938
Phone (818) 845-6206

Other identifiers 2

IdentifierTypeStateIssuer
00A347741MedicaidCA
00A347740OtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
34774CAMDClinical Psychologist
A34774CAMDAnesthesiology Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1235143306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S 1ST ST",
            "address_2": "1000",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915021938",
            "telephone_number": "818-845-6206",
            "fax_number": "818-845-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 SYCAMORE DR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930651201",
            "telephone_number": "805-955-6900",
            "fax_number": "805-955-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLAL",
        "first_name": "VIVEK",
        "middle_name": "RATNAKAR",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A34774",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A347741",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A347740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.