Basic Information
| Provider Information | |||||||||
| NPI: | 1881865855 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SRIKANTH S RAO D O A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 S LA CIENEGA BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103292469 | ||||||||
| FaxNumber: | 3103290176 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 S LA CIENEGA BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103292469 | ||||||||
| FaxNumber: | 3103290176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2008 | ||||||||
| LastUpdateDate: | 06/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | RAO | ||||||||
| AuthorizedOfficialFirstName: | SRIKANTH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3103292469 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 20A8793 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6985137 | 05 | CA | MEDICAID |