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General NPI Number Information
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NPI Number | 1245646959
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Entity Type | Organization
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Legal Business Name | RAVI K LAKKARAJU MD INC
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Dates
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Enumeration Date | 07/02/2014
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 15725 POMERADO RD STE 105
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City | POWAY
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State | CA
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Zip | 92064-2057
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Country | US
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Telephone | 858-485-1846
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Fax | 858-485-8676
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Provider Business Mailing Address
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Address Line | 15725 POMERADO RD STE 105
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City | POWAY
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State | CA
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Zip | 92064-2057
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Country | US
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Telephone | 858-485-1846
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Fax | 858-485-8676
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAVI K LAKKARAJU
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Credential | MD
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Telephone | 858-485-1846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | C55361
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License Number State | CA
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