Provider Demographics
NPI:1104848191
Name:NAIR, SREEKUMAR P (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEKUMAR
Middle Name:P
Last Name:NAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4170
Mailing Address - Fax:831-454-4663
Practice Address - Street 1:1400 EMELINE AVE
Practice Address - Street 2:STE 100
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1976
Practice Address - Country:US
Practice Address - Phone:831-454-4170
Practice Address - Fax:831-454-4663
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1050972084P0800X
CAC1439162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70042FOtherSANTA CRUZ COUNTY IN CA MEDI-CAL GROUP#S
MO207659442Medicaid
CAC143916OtherPHYSICIAN AND SURGEON LICENSE
CAFHC70044FOtherSANTA CRUZ COUNTY IN CA MEDI-CAL GROUP#S
CAFHC70044FOtherSANTA CRUZ COUNTY IN CA MEDI-CAL GROUP#S
CAZZZ91891ZMedicare PIN
CABN4118976OtherDEA LICENSE
CAFHC70044FOtherSANTA CRUZ COUNTY IN CA MEDI-CAL GROUP#S