Healthcare Provider Details

I. General information

NPI: 1730153172
Provider Name (Legal Business Name): PRIYA DARSHINI KRISHNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 ORANGE TREE LN STE 102
REDLANDS CA
92374-0112
US

IV. Provider business mailing address

11234 ANDERSON ST STE 2580
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2600
  • Fax: 909-651-8796
Mailing address:
  • Phone: 909-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD423710
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: