Healthcare Provider Details

I. General information

NPI: 1710379532
Provider Name (Legal Business Name): SRIVARSHINI CHERUKUPALLI MOHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SRIVARSHINI ELLAPRAGADA CHERUKUPALLI MD

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 N HARBOR BLVD STE 3200
FULLERTON CA
92835-3826
US

IV. Provider business mailing address

2151 N HARBOR BLVD STE 3200
FULLERTON CA
92835-3826
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5900
  • Fax: 714-446-5240
Mailing address:
  • Phone: 714-446-5900
  • Fax: 714-446-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberU9314
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA165878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: