MEDICARE: T SRI MD A PROFESSIONAL CORP

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	173000000X	Legal Medicine	A33938	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568687317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T SRI MD A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	44725 10TH ST W STE 230
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3048
Country	:	US
Telephone Number	:	661-948-1611
Fax Number	:	661-945-5291

Provider Business Practice Location Address
First Line	:	9278 N LOOP BLVD
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2236
Country	:	US
Telephone Number	:	760-373-4809
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THILLAIAMPALAM SRIJAERAJAH
Credential	:	M.D.
Telephone Number	:	760-373-4809

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	10/26/2010

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Directions to “T SRI MD A PROFESSIONAL CORP ” Practice Location

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