Provider Demographics
NPI:1316028533
Name:MYNENI, LAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAKSHMI
Middle Name:
Last Name:MYNENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2490 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4124
Mailing Address - Country:US
Mailing Address - Phone:650-969-7006
Mailing Address - Fax:650-969-7007
Practice Address - Street 1:2490 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4124
Practice Address - Country:US
Practice Address - Phone:650-969-7006
Practice Address - Fax:650-969-7007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA049704207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A497040Medicare PIN
CAF41224Medicare UPIN