Healthcare Provider Details

I. General information

NPI: 1104713197
Provider Name (Legal Business Name): SARAYU SRINIVASAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 06/21/2025
Certification Date: 06/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 E LINDO AVE STE B
CHICO CA
95926-2266
US

IV. Provider business mailing address

6371 VIEWPOINT DR
SAN DIEGO CA
92139-2437
US

V. Phone/Fax

Practice location:
  • Phone: 800-430-4490
  • Fax:
Mailing address:
  • Phone: 848-218-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: