Basic Information
| Provider Information | |||||||||
| NPI: | 1215376702 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GAJALAKSHMI VAKA, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1149 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853801149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235832073 | ||||||||
| FaxNumber: | 6235831099 | ||||||||
| Practice Location | |||||||||
| Address1: | 7183 W CAMINO DE ORO | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853833264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235832073 | ||||||||
| FaxNumber: | 6235831099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2013 | ||||||||
| LastUpdateDate: | 06/18/2013 | ||||||||
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| AuthorizedOfficialLastName: | VAKA | ||||||||
| AuthorizedOfficialFirstName: | GAJALAKSHMI | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6235832073 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 29540 | AZ | Y | Hospitals | General Acute Care Hospital |
No ID Information.