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NPI Code Detail

MEDICARE: VIJAYALAKSHMI MANDAYAM RANGANATH MD

MEDICARE: VIJAYALAKSHMI MANDAYAM RANGANATH 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
12084P0804XChild & Adolescent Psychiatry PhysicianA29559CA
22084P0800XPsychiatry PhysicianA29559CA

General Provider Information

NPI Number : 1982782967
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIJAYALAKSHMI MANDAYAM RANGANATH MD
Provider Business Mailing Address
First Line : 11601 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5006
Country : US
Telephone Number : 323-242-5000
Fax Number :
Provider Business Practice Location Address
First Line : 11601 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-5006
Country : US
Telephone Number : 323-242-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 09/22/2022

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