Healthcare Provider Details

I. General information

NPI: 1295763605
Provider Name (Legal Business Name): LAKSHMANAN SATHYAVAGISWARAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 W DUARTE RD G549
ARCADIA CA
91007-7564
US

IV. Provider business mailing address

713 W DUARTE RD G 549
ARCADIA CA
91007-7564
US

V. Phone/Fax

Practice location:
  • Phone: 626-353-4321
  • Fax:
Mailing address:
  • Phone: 626-353-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA30609
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA30609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: