MEDICARE: MR. SREENIVASA RAO NAKKA M.D,F.A.C.P,F.A.C.G

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	A38525	CA
2	207R00000X	Internal Medicine Physician	A38525	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	953869393	OTHER	CA	TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184666547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SREENIVASA RAO NAKKA M.D,F.A.C.P,F.A.C.G

Provider Business Mailing Address
First Line	:	949 CALHOUN PL
Second Line	:	STE A
City	:	HEMET
State	:	CA
Zip	:	92543-4403
Country	:	US
Telephone Number	:	951-929-1177
Fax Number	:	951-765-9111

Provider Business Practice Location Address
First Line	:	949 CALHOUN PL
Second Line	:	SUITE A
City	:	HEMET
State	:	CA
Zip	:	92543-4403
Country	:	US
Telephone Number	:	951-929-1177
Fax Number	:	951-765-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/15/2016

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