Provider Demographics
NPI:1962574426
Name:LOPANSRI, SUMALA
Entity type:Individual
Prefix:DR
First Name:SUMALA
Middle Name:
Last Name:LOPANSRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUMALA
Other - Middle Name:
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:223 N GARFIELD AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1700
Mailing Address - Country:US
Mailing Address - Phone:626-573-5005
Mailing Address - Fax:
Practice Address - Street 1:223 N GARFIELD AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1700
Practice Address - Country:US
Practice Address - Phone:626-573-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33915207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA 33915BOtherMEDICARE PROVIDER NUMBER
CAGR0008161OtherMEDICAL PROVIDER NUMBER
CAA84536Medicare UPIN