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General NPI Number Information
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NPI Number | 1386171320
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Entity Type | Individual
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Provider Name | LAKSHMI VILASITHA KOCHERLAKOTA MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 18185 N 83RD AVE STE 107
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City | GLENDALE
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State | AZ
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Zip | 85308-0520
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Country | US
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Telephone | 623-583-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 10125 E MEADOW HILL DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-9215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 61525
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License Number State | AZ
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