Individual
DR. PADMANABHA S SHAKKOTTAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3650 SOUTH ST, SUITE 308, LAKEWOOD, CA 90712-1502
(562) 633-2204
(562) 633-2579
Mailing address
3650 SOUTH ST, SUITE 308, LAKEWOOD, CA 90712-1502
(562) 633-2275
(562) 633-0017
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
35.087634
OH
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A74331
CA
207RP1001X
Pulmonary Disease Physician
35.087634
OH
207RP1001X
Pulmonary Disease Physician
Primary
A74331
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164472346
—
CA
05
—
200822020
—
IN
05
—
2666502
—
OH
05
—
64118847
—
KY
Enumeration date
05/11/2006
Last updated
09/07/2011
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