Healthcare Provider Details

I. General information

NPI: 1427197060
Provider Name (Legal Business Name): LEELAKRISHNA NALLAMSHETTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 UTAH AVE STE 200
EL SEGUNDO CA
90245-4817
US

IV. Provider business mailing address

2330 UTAH AVE
EL SEGUNDO CA
90245-4817
US

V. Phone/Fax

Practice location:
  • Phone: 813-245-5257
  • Fax:
Mailing address:
  • Phone: 424-290-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME101248
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME101248
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME101248
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME101248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: