Provider Demographics
NPI:1346321510
Name:YANAMADALA, SRINIVAS (MD)
Entity type:Individual
Prefix:DR
First Name:SRINIVAS
Middle Name:
Last Name:YANAMADALA
Suffix:
Gender:M
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 3540
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-9504
Mailing Address - Country:US
Mailing Address - Phone:310-316-4436
Mailing Address - Fax:310-316-3147
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4909
Practice Address - Country:US
Practice Address - Phone:310-316-4436
Practice Address - Fax:310-316-3147
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49479207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A494791Medicaid
CAA49479OtherMEDICAL LICENSE
CAA49479Medicare ID - Type Unspecified
CA00A494791Medicaid