Basic Information
Provider Information
NPI: 1003002049
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SRINIVASAN
FirstName: LAKSHMI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2350 W EL CAMINO REAL
Address2: 2ND FLOOR
City: MOUNTAIN VIEW
State: CA
PostalCode: 940406201
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3200 KEARNEY ST
Address2:  
City: FREMONT
State: CA
PostalCode: 945382299
CountryCode: US
TelephoneNumber: 5104901222
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 02/10/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101XA89273CAY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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