Healthcare Provider Details

I. General information

NPI: 1851974166
Provider Name (Legal Business Name): SRIDIVYA MAJJI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 EL CAMINO REAL
SANTA CLARA CA
95051-3007
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-3801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: