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General NPI Number Information
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NPI Number | 1073660080
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Entity Type | Individual
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Provider Name | MADHANIKA LAASYA SRIRAMA MD
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 887 POTRERO AVE L UNIT
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2869
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Country | US
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Telephone | 510-317-1437
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Fax | 510-276-6828
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Provider Business Mailing Address
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Address Line | 1380 HOWARD ST 5TH FLOOR
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City | SAN FRANCISCO
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State | CA
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Zip | 94103-2638
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Country | US
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Telephone | 415-255-3919
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Fax | 415-255-3567
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A83510
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License Number State | CA
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