Provider Demographics
NPI:1780346577
Name:LAKSHMI MYNENI MD
Entity type:Organization
Organization Name:LAKSHMI MYNENI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MYNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-291-4150
Mailing Address - Street 1:2490 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4124
Mailing Address - Country:US
Mailing Address - Phone:650-969-7006
Mailing Address - Fax:650-969-7007
Practice Address - Street 1:2490 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4124
Practice Address - Country:US
Practice Address - Phone:650-969-7006
Practice Address - Fax:650-969-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty