Healthcare Provider Details

I. General information

NPI: 1710065586
Provider Name (Legal Business Name): SRINIVAS R. RAMACHANDRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 EL CAPITAN DR STE 120
DANVILLE CA
94526-6260
US

IV. Provider business mailing address

1320 EL CAPITAN DR STE 120
DANVILLE CA
94526-6260
US

V. Phone/Fax

Practice location:
  • Phone: 510-579-2345
  • Fax:
Mailing address:
  • Phone: 510-579-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA38624
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA38624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: