Provider Demographics
NPI:1508084518
Name:SUMALA LOPANSRI
Entity Type:Organization
Organization Name:SUMALA LOPANSRI
Other - Org Name:LO MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN AND SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:SUMALA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPANSRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-573-5005
Mailing Address - Street 1:223 N GARFIELD AVE.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754
Mailing Address - Country:US
Mailing Address - Phone:626-573-5005
Mailing Address - Fax:
Practice Address - Street 1:223 N GARFIELD AVE.
Practice Address - Street 2:SUITE 306
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754
Practice Address - Country:US
Practice Address - Phone:626-573-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33915207N00000X
CAA33669207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR 0008161Medicaid
CAW964AMedicare PIN
CAGR 0008161Medicaid