Provider Demographics
NPI:1083887665
Name:MAHENDRAN, LAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:MAHENDRAN
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 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-490-1222
Mailing Address - Fax:
Practice Address - Street 1:20411 VIA PAVISO
Practice Address - Street 2:APT B26
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-6323
Practice Address - Country:US
Practice Address - Phone:954-384-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100424207R00000X
CAA106178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine