MEDICARE: SIRISH NAKKA 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	207R00000X	Internal Medicine Physician	A169418	CA
2	207R00000X	Internal Medicine Physician	PENDING	CA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RS0012X	Sleep Medicine (Internal Medicine) Physician	A169418	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A169418	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1619406725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRISH NAKKA MD

Provider Business Mailing Address
First Line	:	1665 DOMINICAN WAY STE 222
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1515
Country	:	US
Telephone Number	:	844-387-5337
Fax Number	:	866-264-3890

Provider Business Practice Location Address
First Line	:	1665 DOMINICAN WAY STE 222
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1515
Country	:	US
Telephone Number	:	844-387-5337
Fax Number	:	866-264-3890

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

Provider Enumeration Date	:	06/12/2017
Last Update Date	:	03/07/2023

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Directions to “ SIRISH NAKKA MD” Practice Location

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