Provider Demographics
NPI:1518331537
Name:NALLURI PLASTIC SURGERY AND LASER CENTER PA
Entity Type:Organization
Organization Name:NALLURI PLASTIC SURGERY AND LASER CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJASEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-299-8999
Mailing Address - Street 1:724 MUIRLANDS VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6201
Mailing Address - Country:US
Mailing Address - Phone:858-299-9999
Mailing Address - Fax:858-225-1855
Practice Address - Street 1:724 MUIRLANDS VISTA WAY
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-6201
Practice Address - Country:US
Practice Address - Phone:858-299-9999
Practice Address - Fax:858-225-1855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10504ZMedicare UPIN
FLK3731Medicare UPIN