Healthcare Provider Details

I. General information

NPI: 1508084518
Provider Name (Legal Business Name): SUMALA LOPANSRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N GARFIELD AVE. SUITE 306
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

223 N GARFIELD AVE. SUITE 306
MONTEREY PARK CA
91754
US

V. Phone/Fax

Practice location:
  • Phone: 626-573-5005
  • Fax:
Mailing address:
  • Phone: 626-573-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA33915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA33669
License Number StateCA

VIII. Authorized Official

Name: SUMALA LOPANSRI
Title or Position: PHYSICIAN AND SURGEON
Credential: M.D.
Phone: 626-573-5005