Healthcare Provider Details

I. General information

NPI: 1881865855
Provider Name (Legal Business Name): SRIKANTH S RAO D O A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S LA CIENEGA BLVD SUITE 200
BEVERLY HILLS CA
90211-3328
US

IV. Provider business mailing address

239 S LA CIENEGA BLVD SUITE 200
BEVERLY HILLS CA
90211-3328
US

V. Phone/Fax

Practice location:
  • Phone: 310-329-2469
  • Fax: 310-329-0176
Mailing address:
  • Phone: 310-329-2469
  • 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: DR. SRIKANTH S RAO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 310-329-2469