MEDICARE: DR. ANANTHA LAKSHMI PANYALA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY19551	CA

General Provider Information

NPI Number	:	1134146889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANANTHA LAKSHMI PANYALA PHD

Provider Business Mailing Address
First Line	:	2150 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1337
Country	:	US
Telephone Number	:	916-876-5605
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1337
Country	:	US
Telephone Number	:	916-876-5605
Fax Number	:	916-875-1005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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