Provider Demographics
NPI:1649596032
Name:SRINIVASA, DHIVYA (MD)
Entity type:Individual
Prefix:
First Name:DHIVYA
Middle Name:
Last Name:SRINIVASA
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 1:5887 ANNIE OAKLEY RD
Mailing Address - Street 2:
Mailing Address - City:HIDDEN HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1200
Mailing Address - Country:US
Mailing Address - Phone:818-671-7956
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DR STE 220
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1046
Practice Address - Country:US
Practice Address - Phone:818-336-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-11
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134641208200000X, 390200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program