Provider Demographics
NPI:1629073622
Name:RAMANUJAM, LAKSHMI S (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAKSHMI
Middle Name:S
Last Name:RAMANUJAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 J STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:916-736-2710
Mailing Address - Fax:916-736-3240
Practice Address - Street 1:3701 J ST
Practice Address - Street 2:STE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5542
Practice Address - Country:US
Practice Address - Phone:916-736-2710
Practice Address - Fax:916-736-3240
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2015-03-12
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAA042533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC49480Medicare UPIN
CA00A425330Medicare ID - Type Unspecified