Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | A121488 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | A121488 | CA |
NPI | 1194734087 |
---|---|
Provider Name | Ajay Venkatesh Srivastava |
First Address | San Diego, CA 92127-5705 |
Second Address | La Jolla, CA 92037-1205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 18/12/2019 |