MEDICARE: DR. LATA KUMARASWAMY D.O.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	005374	AZ

General Provider Information

NPI Number	:	1164648226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATA KUMARASWAMY D.O.

Provider Business Mailing Address
First Line	:	6220 W BELL RD STE 130
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3896
Country	:	US
Telephone Number	:	602-547-7348
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 W BELL RD STE 130
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-3896
Country	:	US
Telephone Number	:	602-547-7348
Fax Number	:

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/25/2022

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