Provider Demographics
NPI:1659355824
Name:TEGULAPALLE, LAKSHMI C (DO)
Entity Type:Individual
Prefix:
First Name:LAKSHMI
Middle Name:C
Last Name:TEGULAPALLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N 1ST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7027
Mailing Address - Country:US
Mailing Address - Phone:626-698-7246
Mailing Address - Fax:626-447-1058
Practice Address - Street 1:100 W CALIFORNIA BLVD
Practice Address - Street 2:RADIOLOGY DEPT.
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3010
Practice Address - Country:US
Practice Address - Phone:626-397-5139
Practice Address - Fax:626-447-1058
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A102972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A102970OtherBLUE SHIELD OF CALIFORNIA
CAW20A10297BMedicare PIN
CA20A102970OtherBLUE SHIELD OF CALIFORNIA
CAW20A10297EMedicare PIN
CAI45171Medicare UPIN
CAW20A10297AMedicare PIN
CAW20A10297CMedicare PIN
CAW20A10297DMedicare PIN