Healthcare Provider Details

I. General information

NPI: 1184666547
Provider Name (Legal Business Name): SREENIVASA RAO NAKKA M.D,F.A.C.P,F.A.C.G
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 CALHOUN PL SUITE A
HEMET CA
92543-4403
US

IV. Provider business mailing address

949 CALHOUN PL STE A
HEMET CA
92543-4403
US

V. Phone/Fax

Practice location:
  • Phone: 951-929-1177
  • Fax: 951-765-9111
Mailing address:
  • Phone: 951-929-1177
  • Fax: 951-765-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA38525
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA38525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: