MEDICARE: DHIVYA SRINIVASA M.D.

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	208200000X	Plastic Surgery Physician	A134641	CA

General Provider Information

NPI Number	:	1649596032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHIVYA SRINIVASA M.D.

Provider Business Mailing Address
First Line	:	5887 ANNIE OAKLEY RD
Second Line	:
City	:	HIDDEN HILLS
State	:	CA
Zip	:	91302-1200
Country	:	US
Telephone Number	:	818-671-7956
Fax Number	:

Provider Business Practice Location Address
First Line	:	29229 CANWOOD ST STE 101
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-1503
Country	:	US
Telephone Number	:	818-336-1295
Fax Number	:

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

Provider Enumeration Date	:	04/11/2010
Last Update Date	:	08/09/2025

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