Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 5101026208 | MI |
NPI | 1043710221 |
---|---|
Provider Name | Sruti Aiyaswamy |
First Address | San Jose, CA 95138-2245 |
Second Address | Tulsa, OK 74127-9020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/12/2021 |