Provider Demographics
NPI:1023552122
Name:CHALLA, LAXMI (MD)
Entity Type:Individual
Prefix:
First Name:LAXMI
Middle Name:
Last Name:CHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAXMI
Other - Middle Name:
Other - Last Name:CHALLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:608 HARDCASTLE CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-6015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:608 HARDCASTLE CT
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-6015
Practice Address - Country:US
Practice Address - Phone:408-715-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine