Provider Demographics
NPI:1760472567
Name:VATS, VEENA VANMALA (MD)
Entity type:Individual
Prefix:
First Name:VEENA
Middle Name:VANMALA
Last Name:VATS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 S MERCY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0429
Mailing Address - Country:US
Mailing Address - Phone:480-558-3223
Mailing Address - Fax:480-558-5152
Practice Address - Street 1:3485 S MERCY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0429
Practice Address - Country:US
Practice Address - Phone:480-558-3223
Practice Address - Fax:480-558-5152
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34172207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ212627Medicaid