Healthcare Provider Details

I. General information

NPI: 1295247484
Provider Name (Legal Business Name): SNIGDHA KALVAKOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2017
Last Update Date: 10/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 COUNTRY CLUB DR UNIT D
SIMI VALLEY CA
93065-7691
US

IV. Provider business mailing address

5377 WILLOW OAK ST
SIMI VALLEY CA
93063-4592
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-2053
  • Fax: 805-404-8077
Mailing address:
  • Phone: 805-579-8207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: