Provider Demographics
NPI:1174785810
Name:VIJAYASARATHI, KRISHNA (DO)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:VIJAYASARATHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TRUXTUN AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0679
Mailing Address - Country:US
Mailing Address - Phone:661-323-6410
Mailing Address - Fax:661-323-7631
Practice Address - Street 1:6001 TRUXTUN AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0679
Practice Address - Country:US
Practice Address - Phone:661-323-6410
Practice Address - Fax:661-323-7631
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11315103K00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst