Provider Demographics
NPI:1891779740
Name:CHERUVATTATH, REKHA (MD)
Entity Type:Individual
Prefix:
First Name:REKHA
Middle Name:
Last Name:CHERUVATTATH
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-861-1486
Mailing Address - Fax:
Practice Address - Street 1:8120 TIMBERLAKE WAY STE 101
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5413
Practice Address - Country:US
Practice Address - Phone:916-681-6159
Practice Address - Fax:916-689-4095
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107830207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80876ZMedicaid
CADJ816ZOtherPTAN
CA103063Medicare PIN
CAI24745Medicare UPIN