Basic Information
| Provider Information | |||||||||
| NPI: | 1790906568 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBBIAH | ||||||||
| FirstName: | VISHAKALAKSHMI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7515 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914051949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189474026 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7515 VAN NUYS BLVD | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914051949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189474026 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | A97861 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.