Healthcare Provider Details

I. General information

NPI: 1073860664
Provider Name (Legal Business Name): RADHIKA ANANTHAKRISHNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 COYLE AVE SUITE 200
CARMICHAEL CA
95648
US

IV. Provider business mailing address

6555 COYLE AVE SUITE 200
CARMICHAEL CA
95648
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-4612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA120305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: