Provider Demographics
NPI:1760825871
Name:SANJAY SRIVATSA MD INC
Entity Type:Organization
Organization Name:SANJAY SRIVATSA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SRIVATSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-224-5003
Mailing Address - Street 1:7206 N MILBURN AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8450
Mailing Address - Country:US
Mailing Address - Phone:559-224-5003
Mailing Address - Fax:559-271-8040
Practice Address - Street 1:7206 N MILBURN AVE STE 105
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8450
Practice Address - Country:US
Practice Address - Phone:559-224-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588603369OtherNPI