Organization
RAVI K LAKKARAJU MD INC
Active
Other names
Poway Spine and Pain
Organization subpart
No
Provider details
NPI number
Authorized official
RAVI K LAKKARAJU MD (PRESIDENT)
(858) 485-1846
Entity
Organization
Contact information
Practice address
15725 POMERADO RD STE 105, POWAY, CA 92064-2057
(858) 485-1846
(858) 485-8676
Mailing address
15725 POMERADO RD STE 105, POWAY, CA 92064-2057
(858) 485-1846
(858) 485-8676
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
C55361
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C55361
CALIFORNIA MEDICAL LICENSE
CA
Enumeration date
07/02/2014
Last updated
07/02/2014
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