Provider Demographics
NPI:1184666547
Name:NAKKA, SREENIVASA RAO (MD,FACP,FACG)
Entity Type:Individual
Prefix:MR
First Name:SREENIVASA
Middle Name:RAO
Last Name:NAKKA
Suffix:
Gender:M
Credentials:MD,FACP,FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 CALHOUN PL
Mailing Address - Street 2:STE A
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4403
Mailing Address - Country:US
Mailing Address - Phone:951-929-1177
Mailing Address - Fax:951-765-9111
Practice Address - Street 1:949 CALHOUN PL
Practice Address - Street 2:SUITE A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4403
Practice Address - Country:US
Practice Address - Phone:951-929-1177
Practice Address - Fax:951-765-9111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38525207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953869393OtherTAX ID
CA6764017Medicaid
CA6764017Medicaid
CA00A385850Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER