Healthcare Provider Details

I. General information

NPI: 1750569133
Provider Name (Legal Business Name): SWATI VIJAYLAKSHMI ELCHURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE STE 302
VENTURA CA
93003-1651
US

IV. Provider business mailing address

3701 WILSHIRE BLVD STE 600
LOS ANGELES CA
90010-2814
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6255
  • Fax:
Mailing address:
  • Phone: 323-361-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA149522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: