Provider Demographics
NPI:1700819422
Name:DOMA, SIVA P (MD)
Entity Type:Individual
Prefix:MR
First Name:SIVA
Middle Name:P
Last Name:DOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:870 SHASTA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4117
Mailing Address - Country:US
Mailing Address - Phone:530-671-3671
Mailing Address - Fax:530-671-3980
Practice Address - Street 1:870 SHASTA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-4117
Practice Address - Country:US
Practice Address - Phone:530-671-3671
Practice Address - Fax:530-671-3980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07458700207R00000X
PAMD426397207R00000X, 207RG0100X
CODR.0071310207RG0100X
CAC54070207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADO160ZMedicare UPIN
NJH77333Medicare UPIN