Provider Demographics
NPI:1295763605
Name:SATHYAVAGISWARAN, LAKSHMANAN (MD)
Entity type:Individual
Prefix:DR
First Name:LAKSHMANAN
Middle Name:
Last Name:SATHYAVAGISWARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 W DUARTE RD
Mailing Address - Street 2:G 549
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7564
Mailing Address - Country:US
Mailing Address - Phone:626-353-4321
Mailing Address - Fax:
Practice Address - Street 1:713 W DUARTE RD
Practice Address - Street 2:G549
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7564
Practice Address - Country:US
Practice Address - Phone:626-353-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30609207RI0200X, 207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306090Medicaid
CA00A306090Medicaid