MEDICARE: MR. SIVA P DOMA 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	207R00000X	Internal Medicine Physician	25MA07458700	NJ
2	207R00000X	Internal Medicine Physician	MD426397	PA
3	207RG0100X	Gastroenterology Physician	DR.0071310	CO
4	207RG0100X	Gastroenterology Physician	MD426397	PA
5	207RG0100X	Gastroenterology Physician	C54070	CA

General Provider Information

NPI Number	:	1700819422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SIVA P DOMA M.D.

Provider Business Mailing Address
First Line	:	870 SHASTA ST
Second Line	:	SUITE 200
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4117
Country	:	US
Telephone Number	:	530-671-3671
Fax Number	:	530-671-3980

Provider Business Practice Location Address
First Line	:	870 SHASTA ST
Second Line	:	SUITE 200
City	:	YUBA CITY
State	:	CA
Zip	:	95991-4117
Country	:	US
Telephone Number	:	530-671-3671
Fax Number	:	530-671-3980

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	11/13/2023

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