Provider Demographics
NPI:1487842894
Name:VALLYATHAN, LEKSHMI (MD)
Entity type:Individual
Prefix:
First Name:LEKSHMI
Middle Name:
Last Name:VALLYATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEKSHMI
Other - Middle Name:
Other - Last Name:VALLYATHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:315 MERCY AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8363
Mailing Address - Country:US
Mailing Address - Phone:209-564-3713
Mailing Address - Fax:
Practice Address - Street 1:315 MERCY AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8363
Practice Address - Country:US
Practice Address - Phone:209-564-3713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191774207R00000X
CAA118521207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine