MEDICARE: MRS. LAKSHMI KUMARI AVALA MD

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	208000000X	Pediatrics Physician	A79103	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962473686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAKSHMI KUMARI AVALA MD

Provider Business Mailing Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:	916-789-0889

Provider Business Practice Location Address
First Line	:	902 CIRBY WAY
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4420
Country	:	US
Telephone Number	:	916-789-1798
Fax Number	:	916-789-0889

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/07/2012

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