Healthcare Provider Details

I. General information

NPI: 1609896745
Provider Name (Legal Business Name): SRIKANTH S. RAO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S LA CIENEGA BLVD SUITE 200
BEVERLY HILLS CA
90211
US

IV. Provider business mailing address

PO BOX 5333
TORRANCE CA
90510-5333
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-9566
  • Fax: 310-329-0176
Mailing address:
  • Phone: 310-659-9566
  • Fax: 310-329-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A8793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: