Provider Demographics
NPI:1609981166
Name:DONTHINENI, SRIVALLI (MD)
Entity Type:Individual
Prefix:
First Name:SRIVALLI
Middle Name:
Last Name:DONTHINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W. HWY 30
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737
Mailing Address - Country:US
Mailing Address - Phone:225-647-8511
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:1125 W HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5004
Practice Address - Country:US
Practice Address - Phone:225-647-8511
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15830R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1476951Medicaid
LA4J497Medicare PIN
I27671Medicare UPIN