Healthcare Provider Details

I. General information

NPI: 1306020367
Provider Name (Legal Business Name): P.N.VARMA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W #115
LANCASTER CA
93534-4014
US

IV. Provider business mailing address

444215 15TH ST WEST #115
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-5929
  • Fax: 661-949-5083
Mailing address:
  • Phone: 661-949-5929
  • Fax: 661-949-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA329710
License Number StateCA

VIII. Authorized Official

Name: DR. PENMETSA NARASIMHA VARMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-949-5929