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General NPI Number Information
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NPI Number | 1508185406
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Entity Type | Individual
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Provider Name | LAXMI SUDARSHAN IYER M.D.,
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Gender | Female
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 4500 BROCKTON AVE STE 107
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City | RIVERSIDE
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State | CA
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Zip | 92501-4006
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Country | US
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Telephone | 951-276-2760
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Fax | 951-276-2960
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Provider Business Mailing Address
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Address Line | 6827 W TROPICANA AVE STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89103-4920
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Country | US
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Telephone | 800-881-4226
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Fax | 702-960-4190
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | A165408
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | A165408
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License Number State | CA
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