MEDICARE: MAMATHA SIRICILLA M.B.B.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A148859	CA
2	207RH0000X	Hematology (Internal Medicine) Physician	A148859	CA
3	207RH0003X	Hematology & Oncology Physician	148859	CA
4	207RX0202X	Medical Oncology Physician	A148859	CA

General Provider Information

NPI Number	:	1487967576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMATHA SIRICILLA M.B.B.S

Provider Business Mailing Address
First Line	:	3581 PALMER DR STE 400
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8237
Country	:	US
Telephone Number	:	530-676-6600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3581 PALMER DR STE 400
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8237
Country	:	US
Telephone Number	:	530-676-6600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	10/08/2024

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