Provider Demographics
NPI:1487649604
Name:SIVAPALAN, SIVAKAMI K
Entity Type:Individual
Prefix:
First Name:SIVAKAMI
Middle Name:K
Last Name:SIVAPALAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 LUCY LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8612
Mailing Address - Country:US
Mailing Address - Phone:951-808-8627
Mailing Address - Fax:951-808-8627
Practice Address - Street 1:1824 LUCY LN
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-8612
Practice Address - Country:US
Practice Address - Phone:951-808-8627
Practice Address - Fax:951-808-8627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64125208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A641250Medicaid
CA00A641250Medicaid
H28792Medicare UPIN