Provider Demographics
NPI:1467206623
Name:SRIDEVIBANKA INTEGRATIVE PSYCHIATRIC NURSING SERVICES INC
Entity Type:Organization
Organization Name:SRIDEVIBANKA INTEGRATIVE PSYCHIATRIC NURSING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SRIDEVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-815-8712
Mailing Address - Street 1:11501 DUBLIN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2827
Mailing Address - Country:US
Mailing Address - Phone:510-815-8712
Mailing Address - Fax:
Practice Address - Street 1:11501 DUBLIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2827
Practice Address - Country:US
Practice Address - Phone:510-815-8712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty