Provider Demographics
NPI:1134161854
Name:TRIVEDI, NAYANA M (MD)
Entity type:Individual
Prefix:DR
First Name:NAYANA
Middle Name:M
Last Name:TRIVEDI
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 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:760-436-2449
Mailing Address - Fax:760-632-9169
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:760-436-2449
Practice Address - Fax:760-632-9169
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC043349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C433490Medicaid
CAC43349Medicare PIN
CA00C433490Medicaid