Healthcare Provider Details

I. General information

NPI: 1174761308
Provider Name (Legal Business Name): MOHAN RAO, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MARGUERITA AVE #2
ALHAMBRA CA
91801-3219
US

IV. Provider business mailing address

114 S MARGUERITA AVE #2
ALHAMBRA CA
91801-3219
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-1560
  • Fax:
Mailing address:
  • Phone: 626-331-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA 62446
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAN P RAO
Title or Position: DOCTOR
Credential: MD
Phone: 626-331-1560