Provider Demographics
NPI:1750566154
Name:KUMMATI, DEEPA LAKSHMI (MD)
Entity type:Individual
Prefix:
First Name:DEEPA
Middle Name:LAKSHMI
Last Name:KUMMATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPALAKSHMI
Other - Middle Name:
Other - Last Name:KUMMATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4900 CALIFORNIA AVE STE 400B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7081
Mailing Address - Country:US
Mailing Address - Phone:217-361-7374
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 400B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7081
Practice Address - Country:US
Practice Address - Phone:217-361-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC153084207R00000X
IL036121895208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3218000Medicaid