Provider Demographics
NPI:1215376702
Name:GAJALAKSHMI VAKA, MD PC
Entity Type:Organization
Organization Name:GAJALAKSHMI VAKA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GAJALAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-583-2073
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-1149
Mailing Address - Country:US
Mailing Address - Phone:623-583-2073
Mailing Address - Fax:623-583-1099
Practice Address - Street 1:7183 W CAMINO DE ORO
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-3264
Practice Address - Country:US
Practice Address - Phone:623-583-2073
Practice Address - Fax:623-583-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29540282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital