Provider Demographics
NPI:1700486784
Name:SROTAS
Entity Type:Organization
Organization Name:SROTAS
Other - Org Name:ACUVEDA HOLISTIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SIVARAMA
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:VINJAMURY
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:562-397-9684
Mailing Address - Street 1:14758 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-4250
Mailing Address - Country:US
Mailing Address - Phone:562-646-7476
Mailing Address - Fax:562-309-8239
Practice Address - Street 1:14758 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-4250
Practice Address - Country:US
Practice Address - Phone:562-646-7476
Practice Address - Fax:562-309-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty