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General NPI Number Information
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NPI Number | 1659865913
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Entity Type | Individual
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Provider Name | SRINATH SENGUTTUVAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 1800 WESTERN AVE STE 204
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City | SAN BERNARDINO
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State | CA
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Zip | 92411
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Country | US
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Telephone | 909-474-9952
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Fax |
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Provider Business Mailing Address
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Address Line | 1398 CARISSA ST
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City | UPLAND
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State | CA
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Zip | 91784-7362
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Country | US
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Telephone | 214-592-2762
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | BP10063412
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A180304
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License Number State | CA
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