Healthcare Provider Details

I. General information

NPI: 1205802618
Provider Name (Legal Business Name): AJIT S MANIAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR STE#203
ANAHEIM CA
92801-1830
US

IV. Provider business mailing address

1801 W ROMNEYA DR STE 203
ANAHEIM CA
92801-1824
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-1465
  • Fax: 714-999-1701
Mailing address:
  • Phone: 714-999-1465
  • Fax: 714-999-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA56120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: