Healthcare Provider Details

I. General information

NPI: 1184328064
Provider Name (Legal Business Name): SRAVANI SAI ALLA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

IV. Provider business mailing address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

V. Phone/Fax

Practice location:
  • Phone: 714-367-5390
  • Fax:
Mailing address:
  • Phone: 714-367-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: