Provider Demographics
NPI:1063459204
Name:SUTHAR, LAXMI ACHARYA
Entity Type:Individual
Prefix:DR
First Name:LAXMI
Middle Name:ACHARYA
Last Name:SUTHAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 N HOLLENBECK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1558
Mailing Address - Country:US
Mailing Address - Phone:626-331-2209
Mailing Address - Fax:
Practice Address - Street 1:1433 N HOLLENBECK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1558
Practice Address - Country:US
Practice Address - Phone:626-331-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A874320Medicaid
CAW11675OtherGROUP MEDICARE PIN
CA00A874320OtherBLUE SHIELD
CA1356390009OtherGROUP NPI
CA990005307OtherRAILROAD MEDICARE
CACE1617OtherGROUP RAILROAD MEDICARE
CAGR0016910OtherGROUP MEDICAID PIN
CA1356390009OtherGROUP NPI
CAW11675OtherGROUP MEDICARE PIN