Healthcare Provider Details

I. General information

NPI: 1851480040
Provider Name (Legal Business Name): SUJATA PRASHANT IYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUJATA LAKSHMANAN IYER M.D.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E CHEVY CHASE DR STE 101
GLENDALE CA
91206-4139
US

IV. Provider business mailing address

1530 E CHEVY CHASE DR STE 101
GLENDALE CA
91206-4139
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-7260
  • Fax:
Mailing address:
  • Phone: 818-246-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC51957
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00037524
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: