Provider Demographics
NPI:1609896745
Name:RAO, SRIKANTH S (DO)
Entity Type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5333
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-5333
Mailing Address - Country:US
Mailing Address - Phone:310-659-9566
Mailing Address - Fax:310-329-0176
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-659-9566
Practice Address - Fax:310-329-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A87932081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX87930Medicaid
CA20A8793Medicare PIN