Provider Demographics
NPI:1922714351
Name:SRINIVAS, ANUSHA
Entity Type:Individual
Prefix:
First Name:ANUSHA
Middle Name:
Last Name:SRINIVAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43646 EXCELSO PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6237
Mailing Address - Country:US
Mailing Address - Phone:510-737-8011
Mailing Address - Fax:
Practice Address - Street 1:533 E MICHELTORENA ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2260
Practice Address - Country:US
Practice Address - Phone:805-837-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY1638718106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician