Healthcare Provider Details

I. General information

NPI: 1386630572
Provider Name (Legal Business Name): MURALI SRINIVASAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 ZEPHYR LN UNIT 25
SAN DIEGO CA
92120-2749
US

IV. Provider business mailing address

5248 ZEPHYR LN UNIT 25
SAN DIEGO CA
92120-2749
US

V. Phone/Fax

Practice location:
  • Phone: 360-441-0311
  • Fax:
Mailing address:
  • Phone: 360-441-0311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number14080R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00047234
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: