MEDICARE: DR. SANJAY S SRIVATSA MD

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	207RC0000X	Cardiovascular Disease Physician	C51208	CA

General Provider Information

NPI Number	:	1588603369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY S SRIVATSA MD

Provider Business Mailing Address
First Line	:	7206 N MILBURN AVE
Second Line	:	STE 105
City	:	FRESNO
State	:	CA
Zip	:	93722-8450
Country	:	US
Telephone Number	:	559-224-5003
Fax Number	:	559-271-8040

Provider Business Practice Location Address
First Line	:	7206 N MILBURN AVE STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8450
Country	:	US
Telephone Number	:	559-224-5003
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/08/2021

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