1508084518 NPI number — SUMALA LOPANSRI

Table of content: (NPI 1508084518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508084518 NPI number — SUMALA LOPANSRI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUMALA LOPANSRI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LO MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508084518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
223 N GARFIELD AVE.
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-573-5005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 N GARFIELD AVE.
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-573-5005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPANSRI
Authorized Official First Name:
SUMALA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN AND SURGEON
Authorized Official Telephone Number:
626-573-5005

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A33915 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: A33669 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR 0008161 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com