Provider Demographics
NPI:1831146679
Name:BEVERLY, SHEREEN LUKATHY (MD)
Entity Type:Individual
Prefix:
First Name:SHEREEN
Middle Name:LUKATHY
Last Name:BEVERLY
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:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-0395
Mailing Address - Country:US
Mailing Address - Phone:310-303-3170
Mailing Address - Fax:310-303-3174
Practice Address - Street 1:16812 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3218
Practice Address - Country:US
Practice Address - Phone:310-303-3170
Practice Address - Fax:310-303-3174
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist