Provider Demographics
NPI:1992548184
Name:SRINIVASA, DEYVIKA RAJNI
Entity type:Individual
Prefix:
First Name:DEYVIKA
Middle Name:RAJNI
Last Name:SRINIVASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2134
Mailing Address - Country:US
Mailing Address - Phone:213-585-9971
Mailing Address - Fax:
Practice Address - Street 1:710 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2134
Practice Address - Country:US
Practice Address - Phone:213-585-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist