Provider Demographics
NPI:1811197478
Name:SIVAMANI, RAJA (MD, MS, AHE)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:
Last Name:SIVAMANI
Suffix:
Gender:M
Credentials:MD, MS, AHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4517
Mailing Address - Country:US
Mailing Address - Phone:916-925-6950
Mailing Address - Fax:
Practice Address - Street 1:1495 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4517
Practice Address - Country:US
Practice Address - Phone:916-925-7020
Practice Address - Fax:916-925-3680
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113365207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology