Provider Demographics
NPI:1760525547
Name:MOTURU, KUMARI L (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMARI
Middle Name:L
Last Name:MOTURU
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 1:4983 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3086
Mailing Address - Country:US
Mailing Address - Phone:225-769-1103
Mailing Address - Fax:225-761-5155
Practice Address - Street 1:4983 BLUEBONNET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3086
Practice Address - Country:US
Practice Address - Phone:225-769-1103
Practice Address - Fax:225-761-5155
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07562R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1972088Medicaid
LAF40374Medicare UPIN
LA5R916Medicare ID - Type Unspecified