Provider Demographics
NPI:1831355320
Name:VILASAGAR, NIVEDITHA (MD)
Entity type:Individual
Prefix:MISS
First Name:NIVEDITHA
Middle Name:
Last Name:VILASAGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:NEETHA
Other - Middle Name:
Other - Last Name:VILASAGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4867 W SUNSET BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5969
Mailing Address - Country:US
Mailing Address - Phone:323-783-9541
Mailing Address - Fax:
Practice Address - Street 1:4867 W SUNSET BLVD FL 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5969
Practice Address - Country:US
Practice Address - Phone:323-783-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0424782080P0203X
CAA1100692080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine