Provider Demographics
NPI:1316108491
Name:EKKATI, SRINIDHI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SRINIDHI
Middle Name:
Last Name:EKKATI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2534
Mailing Address - Country:US
Mailing Address - Phone:951-734-4880
Mailing Address - Fax:951-734-7963
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2534
Practice Address - Country:US
Practice Address - Phone:951-734-4880
Practice Address - Fax:951-734-7963
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51846363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical