Basic Information
| Provider Information | |||||||||
| NPI: | 1477614790 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADDA | ||||||||
| FirstName: | SRINIVAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 FAIRMOUNT AVE | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268174701 | ||||||||
| FaxNumber: | 6268174702 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 S FAIR OAKS AVE | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268174747 | ||||||||
| FaxNumber: | 6268174748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 01/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | A78754 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 180045572 | 01 | CA | MEDICARE RAILROAD | OTHER | 00A787540 | 05 | CA | MEDICAID | 00A787540 | 01 | CA | BLUE SHIELD | OTHER |