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General NPI Number Information
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NPI Number | 1154306991
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Entity Type | Individual
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Provider Name | SRINIVAS C GUMMARAJU M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4501 X ST SUITE 3016
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City | SACRAMENTO
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State | CA
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Zip | 95817-2229
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Country | US
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Telephone | 530-749-4400
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Fax | 530-749-4534
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Provider Business Mailing Address
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Address Line | 1290 NORTHGATE DR APT. 53
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City | YUBA CITY
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State | CA
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Zip | 95991-1534
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Country | US
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Telephone | 530-749-4400
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Fax |
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A55763
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License Number State | CA
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