Provider Demographics
NPI:1295927127
Name:MUMMANENI, SRIRAM (MD, MPH)
Entity type:Individual
Prefix:
First Name:SRIRAM
Middle Name:
Last Name:MUMMANENI
Suffix:
Gender:M
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 1:23018 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1106
Mailing Address - Country:US
Mailing Address - Phone:818-225-8444
Mailing Address - Fax:818-591-2520
Practice Address - Street 1:23018 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1106
Practice Address - Country:US
Practice Address - Phone:818-225-8444
Practice Address - Fax:818-591-2520
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA736322083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine