MEDICARE: SIRISHA RAO 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	207L00000X	Anesthesiology Physician	A141626	CA
2	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	A141626	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R73582	OTHER	AZ	PERMIT

General Provider Information

NPI Number	:	1902160914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRISHA RAO M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 WESTWOOD PLZ # 7ICU
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-3220
Country	:	US
Telephone Number	:	310-825-4381
Fax Number	:	310-825-0189

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

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	12/27/2019

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Directions to “ SIRISHA RAO M.D.” Practice Location

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