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General NPI Number Information
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NPI Number | 1194734087
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Entity Type | Individual
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Provider Name | AJAY VENKATESH SRIVASTAVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 1420 KETTNER BLVD STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92101-5373
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Country | US
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Telephone | 844-989-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 1440 COLUMBIA ST APT 1812
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City | SAN DIEGO
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State | CA
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Zip | 92101-3481
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Country | US
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Telephone | 203-415-7473
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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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | A121488
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A121488
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RA0001X
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Taxonomy Name | Advanced Heart Failure and Transplant Cardiology Physician
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License Number | A121488
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License Number State | CA
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