Provider Demographics
NPI:1679696041
Name:SRIRAM, VINODHINI (MD)
Entity type:Individual
Prefix:
First Name:VINODHINI
Middle Name:
Last Name:SRIRAM
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:PO BOX 1277
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90609-1277
Mailing Address - Country:US
Mailing Address - Phone:562-906-6470
Mailing Address - Fax:562-946-9465
Practice Address - Street 1:12522 LAMBERT RD
Practice Address - Street 2:SUITE D
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2758
Practice Address - Country:US
Practice Address - Phone:562-698-0575
Practice Address - Fax:562-945-9756
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96897174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABS9943526OtherDEA