Provider Demographics
NPI:1033208160
Name:VIJAYALAKSHMI, MALAYATTIL (MD)
Entity Type:Individual
Prefix:DR
First Name:MALAYATTIL
Middle Name:
Last Name:VIJAYALAKSHMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 FARQUHAR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2018
Mailing Address - Country:US
Mailing Address - Phone:562-421-8283
Mailing Address - Fax:562-420-8681
Practice Address - Street 1:3325 PALO VERDE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4132
Practice Address - Country:US
Practice Address - Phone:562-421-8283
Practice Address - Fax:562-420-8681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA807452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine