Individual provider Active NPI

Jainy Vathikulam, DO

  • Neurology with Special Qualifications in Child Neurology Physician
  • San Rafael, CA
National Provider Identifier
1407349145
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
20A17874 Issued in CA
Practice address
4000 Civic Center Dr Ste 100
San Rafael, CA 94903-4151
Phone
(628) 877-0040
NPI assigned
Jun 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 20A17874 CA Primary

Addresses

Primary practice location

4000 Civic Center Dr Ste 100
San Rafael, CA 94903-4151

Mailing address

4000 Civic Center Dr Ste 100
San Rafael, CA 94903-4151
Phone (628) 877-0040

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)
Not enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A17874CAMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cortica Healthcare Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jainy.vathikulam.1@14973.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14973/brand/8/csg/1/fhir/r4

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1407349145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR STE 100",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034151",
            "telephone_number": "628-877-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 CIVIC CENTER DR STE 100",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949034151",
            "telephone_number": "628-877-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VATHIKULAM",
        "first_name": "JAINY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "CA",
            "license": "20A17874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.