| |
2625 W Alameda Ave Suite 424 Burbank CA 91505-4806 | |
(818) 848-2351 | |
(818) 848-3164 |
Full Name | |
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Speciality | Family Medicine |
Location | 2625 W Alameda Ave, Burbank, California |
Authorized Official Name and Position | Lakshmidevi V Putta (OWNER) |
Authorized Official Contact | 8188482351 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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2625 W Alameda Ave Suite 424 Burbank CA 91505-4806 Ph: (818) 848-2351 | 2625 W Alameda Ave Suite 424 Burbank CA 91505-4806 Ph: (818) 848-2351 |
NPI Number | 1639457138 |
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Provider Enumeration Date | 08/01/2011 |
Last Update Date | 08/01/2011 |
Medicare PECOS PAC ID | 8325215130 |
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Medicare Enrollment ID | O20120229000088 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639457138 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Lakshmidevi J Putta |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1962435628 PECOS PAC ID: 5698877413 Enrollment ID: I20070226000516 |
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