Provider Demographics
NPI:1366002867
Name:PALIVELA, LAKSHMI
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:
Last Name:PALIVELA
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 1:6898 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1730
Mailing Address - Country:US
Mailing Address - Phone:408-908-7939
Mailing Address - Fax:408-908-7930
Practice Address - Street 1:6898 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1730
Practice Address - Country:US
Practice Address - Phone:408-908-7939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist