Provider Demographics
NPI:1962473686
Name:AVALA, LAKSHMI KUMARI (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAKSHMI
Middle Name:KUMARI
Last Name:AVALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LAKSHMI
Other - Middle Name:KUMARI
Other - Last Name:VOODI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:902 CIRBY WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4420
Mailing Address - Country:US
Mailing Address - Phone:916-789-1798
Mailing Address - Fax:916-789-0889
Practice Address - Street 1:902 CIRBY WAY
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4420
Practice Address - Country:US
Practice Address - Phone:916-789-1798
Practice Address - Fax:916-789-0889
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2146331Medicaid