Provider Demographics
NPI:1194755959
Name:VAKKALANKA, LALITHA M (MD)
Entity type:Individual
Prefix:
First Name:LALITHA
Middle Name:M
Last Name:VAKKALANKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E COMMONWEALTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1905
Mailing Address - Country:US
Mailing Address - Phone:714-572-3900
Mailing Address - Fax:714-572-4300
Practice Address - Street 1:140 E COMMONWEALTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1905
Practice Address - Country:US
Practice Address - Phone:714-773-4111
Practice Address - Fax:714-773-4222
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA053202207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR161133OtherGROUP MEDICAID-NORTH BEND MEDICAL CENTER INC
OR1407812365OtherGROUP NPI - NORTH BEND MEDICAL CENTER INC
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR500607717Medicaid
ORP01176090OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherGROUP MEDICARE-NORTH BEND MEDICAL ENTER INC
OR930635514OtherGROUP TAX ID FOR BILING-NORTH BEND MEDICAL CENTER INC
ORP01176090OtherRR MEDICARE PTAN NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR500607717Medicaid