Provider Demographics
NPI:1821521733
Name:TRIVEDI, RADHIKA RANI (MD; MPH)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:RANI
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:MD; MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:1401 AVOCADO AVE STE 703
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8710
Practice Address - Country:US
Practice Address - Phone:949-751-6683
Practice Address - Fax:949-760-0439
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176430207N00000X, 207N00000X
PAMT216944207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty