Individual
PHANIKUMAR SRINIVASA VADAREVU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1825 BELL ST, SACRAMENTO, CA 95825-1020
(916) 973-5000
Mailing address
1825 BELL ST, SACRAMENTO, CA 95825-1020
(916) 973-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A83555
CA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
A83555
CA
Other
Enumeration date
09/14/2006
Last updated
12/14/2021
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