Provider Demographics
NPI:1902841356
Name:SRIVASTAVA, RAKESH K (CPO)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:K
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7383
Mailing Address - Country:US
Mailing Address - Phone:402-461-4931
Mailing Address - Fax:
Practice Address - Street 1:223 E 14TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3200
Practice Address - Country:US
Practice Address - Phone:402-461-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACPO-02611225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter