Healthcare Provider Details

I. General information

NPI: 1164127361
Provider Name (Legal Business Name): MEGHANA BALAKRISHNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 S ALVARADO ST
LOS ANGELES CA
90057-4021
US

IV. Provider business mailing address

741 S ALVARADO ST
LOS ANGELES CA
90057-4021
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-7551
  • Fax:
Mailing address:
  • Phone: 910-739-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA205262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: