Provider Demographics
NPI:1093893679
Name:AYYALA, SREEDEVI JADCHERLA (MD)
Entity type:Individual
Prefix:
First Name:SREEDEVI
Middle Name:JADCHERLA
Last Name:AYYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2451
Mailing Address - Country:US
Mailing Address - Phone:562-928-9600
Mailing Address - Fax:323-477-1738
Practice Address - Street 1:6001 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2451
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A908550Medicaid
CA00A908550Medicaid