Healthcare Provider Details

I. General information

NPI: 1760408389
Provider Name (Legal Business Name): NIROOP R RAVULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST SUITE 1200
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST SUITE 1200
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5048
  • Fax:
Mailing address:
  • Phone: 916-734-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberF5485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: