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General NPI Number Information
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NPI Number | 1255722146
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Entity Type | Organization
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Legal Business Name | LAKSHMI BANGALOREVATSANSRI
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 10430 S DE ANZA BLVD #230
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City | CUPERTINO
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State | CA
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Zip | 95014-3019
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Country | US
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Telephone | 650-690-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 ALMANOR AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-1209
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Country | US
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Telephone | 650-690-0918
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAKSHMI BANGALOREVATSANSRI
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Credential | MD
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Telephone | 650-690-0918
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A131376
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License Number State | CA
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