Provider Demographics
NPI:1487843454
Name:MAHENDRAN, SRIVIDYA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SRIVIDYA
Middle Name:A
Last Name:MAHENDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4305 UNIVERSITY AVENUE SUITE 150
Mailing Address - Street 2:SAN DIEGO FAMILY CARE, DBA MID-CITY COMMUNITY CLINIC-PE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1601
Mailing Address - Country:US
Mailing Address - Phone:619-280-2058
Mailing Address - Fax:858-633-4682
Practice Address - Street 1:4305 UNIVERISITY AVENUE SUITE 150
Practice Address - Street 2:SAN DIEGO FAMILY CARE, DBA MID-CITY COMMUNITY CLINIC-PE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1601
Practice Address - Country:US
Practice Address - Phone:619-280-2058
Practice Address - Fax:858-633-4682
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92173208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics