Healthcare Provider Details

I. General information

NPI: 1780371658
Provider Name (Legal Business Name): LAVANYA KATTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LAS TABLAS RD
TEMPLETON CA
93465-9758
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-542-6700
  • Fax: 805-542-6791
Mailing address:
  • Phone: 805-361-8030
  • Fax: 805-361-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA208664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: