Healthcare Provider Details

I. General information

NPI: 1750961330
Provider Name (Legal Business Name): SOWMYA SRINIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HUNTINGTON DRIVE
ARCADIA CA
91007
US

IV. Provider business mailing address

2317 GREENFIELD AVE
ARCADIA CA
91006-5226
US

V. Phone/Fax

Practice location:
  • Phone: 626-898-8000
  • Fax:
Mailing address:
  • Phone: 213-447-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA196012
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: