Provider Demographics
NPI:1710379532
Name:MOHAN, SRIVARSHINI CHERUKUPALLI (MD)
Entity type:Individual
Prefix:
First Name:SRIVARSHINI
Middle Name:CHERUKUPALLI
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SRIVARSHINI
Other - Middle Name:ELLAPRAGADA
Other - Last Name:CHERUKUPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2151 N HARBOR BLVD STE 3200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3826
Mailing Address - Country:US
Mailing Address - Phone:714-446-5900
Mailing Address - Fax:714-446-5240
Practice Address - Street 1:2151 N HARBOR BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3826
Practice Address - Country:US
Practice Address - Phone:714-446-5900
Practice Address - Fax:714-446-5240
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9314208600000X
CAA165878208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery