Provider Demographics
NPI:1770224115
Name:SEETHINA, LAKSHMI SUMANTH
Entity type:Individual
Prefix:
First Name:LAKSHMI SUMANTH
Middle Name:
Last Name:SEETHINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 E VAN BUREN ST UNIT 3063
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-0008
Mailing Address - Country:US
Mailing Address - Phone:703-462-3031
Mailing Address - Fax:
Practice Address - Street 1:12340 BANDERA RD STE 104
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4575
Practice Address - Country:US
Practice Address - Phone:210-920-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV8392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine