Provider Demographics
NPI:1518670413
Name:SIVASANKARA PILLAI, RADHIKA (BSN)
Entity Type:Individual
Prefix:MRS
First Name:RADHIKA
Middle Name:
Last Name:SIVASANKARA PILLAI
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W DOWNEY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1489
Mailing Address - Country:US
Mailing Address - Phone:209-988-7101
Mailing Address - Fax:
Practice Address - Street 1:10100 TRINITY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7239
Practice Address - Country:US
Practice Address - Phone:209-953-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95181746163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care