Provider Demographics
NPI:1548287485
Name:SRINIVAS, VASANTHI (MD)
Entity type:Individual
Prefix:
First Name:VASANTHI
Middle Name:
Last Name:SRINIVAS
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 1:2005 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4203
Mailing Address - Country:US
Mailing Address - Phone:661-322-6700
Mailing Address - Fax:
Practice Address - Street 1:2005 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-322-6700
Practice Address - Fax:661-322-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053815207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A538150Medicaid
CAA0053815Medicare ID - Type UnspecifiedMEDICARE
CA00A538150Medicaid