Individual
LAKSHMA R TIYYAGURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 W ACACIA ST, # 18, STOCKTON, CA 95203-2441
(209) 466-4685
(209) 466-4695
Mailing address
PO BOX 7939, STOCKTON, CA 95267-0939
(209) 466-4685
(204) 466-4695
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A56285
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A562850
—
CA
05
—
00A562851
—
CA
Enumeration date
09/14/2006
Last updated
05/11/2009
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