Organization
GREATER VALLEY PHYSICIANS MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKSHMAN MAKANDURA MD (PHYSICIAN/ OWNER)
(626) 961-2461
Entity
Organization
Contact information
Practice address
2219 S HACIENDA BLVD, SUITE 101, HACIENDA HEIGHTS, CA 91745-4639
(626) 961-2461
(626) 330-5392
Mailing address
2219 S HACIENDA BLVD, SUITE 101, HACIENDA HEIGHTS, CA 91745-4639
(626) 961-2461
(626) 330-5392
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A49715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A49715
—
CA
Enumeration date
10/16/2007
Last updated
03/08/2013
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