Provider Demographics
NPI:1194793182
Name:SARMA, PRAVEENA N (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEENA
Middle Name:N
Last Name:SARMA
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 986
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-0986
Mailing Address - Country:US
Mailing Address - Phone:209-339-9036
Mailing Address - Fax:209-339-1901
Practice Address - Street 1:652 W 11TH ST STE 137
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3869
Practice Address - Country:US
Practice Address - Phone:209-833-0998
Practice Address - Fax:209-832-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61533207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AG15331Medicaid
CA00AG15331Medicaid
CA00A615330Medicare ID - Type Unspecified