Provider Demographics
NPI:1134226335
Name:SRIVASTAVA, PRAMOD KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:KUMAR
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 LEXINGTON STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215
Mailing Address - Country:US
Mailing Address - Phone:661-725-0713
Mailing Address - Fax:661-721-2629
Practice Address - Street 1:432 LEXINGTON STREET
Practice Address - Street 2:SUITE C
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-725-0713
Practice Address - Fax:661-721-2629
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51256207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A512560Medicaid
F51010Medicare UPIN
CA00A512560Medicare ID - Type Unspecified