Healthcare Provider Details

I. General information

NPI: 1295910321
Provider Name (Legal Business Name): KANAKA LAKSHMY CHELLIAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KANAKA L CHELLIAH M.D.

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-7334
US

IV. Provider business mailing address

4500 N SONOMA RANCH BLVD
LAS CRUCES NM
88011-7334
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-4048
  • Fax: 575-556-9766
Mailing address:
  • Phone: 575-652-4048
  • Fax: 575-556-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2010-0227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: