Provider Demographics
NPI:1790719953
Name:CHERUVU, RAJALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJALAKSHMI
Middle Name:
Last Name:CHERUVU
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 1:2929 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8034
Mailing Address - Country:US
Mailing Address - Phone:602-470-5000
Mailing Address - Fax:
Practice Address - Street 1:5141 W LAMAR RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-3423
Practice Address - Country:US
Practice Address - Phone:623-344-6700
Practice Address - Fax:623-344-6701
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ718885Medicaid
AZ718885Medicaid
AZZ133903Medicare PIN
AZZ105500Medicare PIN