Healthcare Provider Details

I. General information

NPI: 1962435628
Provider Name (Legal Business Name): LAKSHMIDEVI PUTTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W ALAMEDA AVE SUITE#424
BURBANK CA
91505-4806
US

IV. Provider business mailing address

2625 W ALAMEDA AVE SUITE#424
BURBANK CA
91505-4806
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-2351
  • Fax: 818-848-3164
Mailing address:
  • Phone: 818-848-2351
  • Fax: 818-848-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: