Healthcare Provider Details

I. General information

NPI: 1295830974
Provider Name (Legal Business Name): DR MAHADEV MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CHAPARRAL COURT SUITE 102
ANAHEIM HILLS CA
92808
US

IV. Provider business mailing address

125 CHAPARRAL COURT SUITE 102
ANAHEIM HILLS CA
92808
US

V. Phone/Fax

Practice location:
  • Phone: 714-998-1941
  • Fax: 714-998-3472
Mailing address:
  • Phone: 714-998-1941
  • Fax: 714-998-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MARIGANGAIAH MAHADEV
Title or Position: MD
Credential: MD
Phone: 714-998-1941