1518331537 NPI number — NALLURI PLASTIC SURGERY AND LASER CENTER PA

Table of content: (NPI 1518331537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518331537 NPI number — NALLURI PLASTIC SURGERY AND LASER CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NALLURI PLASTIC SURGERY AND LASER CENTER PA
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:
Provider Other Organization Name Type Code:
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:
1518331537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258 COAST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-4609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-299-9999
Provider Business Mailing Address Fax Number:
858-225-1855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 GIRARD AVE STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-299-8999
Provider Business Practice Location Address Fax Number:
858-225-1855
Provider Enumeration Date:
11/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
NALLURI
Authorized Official First Name:
RAJASEKHAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-299-8999

Provider Taxonomy Codes

  • Taxonomy code: 208200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com