Provider Demographics
NPI:1770218018
Name:BATHINA, SNEHA SRI (DNP-CNM)
Entity type:Individual
Prefix:
First Name:SNEHA
Middle Name:SRI
Last Name:BATHINA
Suffix:
Gender:F
Credentials:DNP-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3807
Mailing Address - Country:US
Mailing Address - Phone:650-823-5000
Mailing Address - Fax:
Practice Address - Street 1:6817 QUAIL HILL PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4234
Practice Address - Country:US
Practice Address - Phone:949-654-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
CANMW236442367A00000X
NYF002142-01176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No176B00000XOther Service ProvidersMidwife