Healthcare Provider Details

I. General information

NPI: 1710733712
Provider Name (Legal Business Name): SRIVIKRAM MARGAM S DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE STE 120
VENTURA CA
93003-1651
US

IV. Provider business mailing address

300 HILLMONT AVE STE 120
VENTURA CA
93003-1651
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6228
  • Fax:
Mailing address:
  • Phone: 805-652-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24596
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number20A24596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: