Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | C161528 | CA |
NPI | 1164775623 |
---|---|
Provider Name | Rachana Srivastava |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-3108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2012 |
Last Update Date | 17/09/2019 |