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General NPI Number Information
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NPI Number | 1215428784
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Entity Type | Organization
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Legal Business Name | LAKSHMI K AVALA MD INC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 5959 GREENBACK LN STE 210
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-4700
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Country | US
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Telephone | 916-722-4565
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Fax | 916-722-5213
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Provider Business Mailing Address
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Address Line | 5959 GREENBACK LN STE 210
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95621-4700
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Country | US
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Telephone | 916-722-4565
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Fax | 916-722-5213
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Authorized Official
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Title or Position | OWNER
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Name | LAKSHMI KUMARI AVALA
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Credential | MD
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Telephone | 916-722-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A79103
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License Number State | CA
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