Healthcare Provider Details

I. General information

NPI: 1104848191
Provider Name (Legal Business Name): SREEKUMAR P. NAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E DAKOTA AVE
FRESNO CA
93726-4821
US

IV. Provider business mailing address

3721 MISSION DR
SANTA CRUZ CA
95065-1632
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-9171
  • Fax:
Mailing address:
  • Phone: 913-486-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC143916
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number105097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: