Healthcare Provider Details

I. General information

NPI: 1083805469
Provider Name (Legal Business Name): MANJU SHIVAN HARIDAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANJU SHIVAN THABOLINGAM M.D.

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 STAGECOACH RD
BELL CANYON CA
91307-1023
US

IV. Provider business mailing address

50 STAGECOACH RD
BELL CANYON CA
91307-1023
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-8444
  • Fax: 813-254-6414
Mailing address:
  • Phone: 813-251-8444
  • Fax: 813-254-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC197028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: