Healthcare Provider Details

I. General information

NPI: 1336168426
Provider Name (Legal Business Name): MANJUL PATWARDHAN M D PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10353 TORRE AVE STE A
CUPERTINO CA
95014-3217
US

IV. Provider business mailing address

20472 GLASGOW DR
SARATOGA CA
95070-4326
US

V. Phone/Fax

Practice location:
  • Phone: 408-725-1777
  • Fax:
Mailing address:
  • Phone: 408-219-3130
  • Fax: 408-725-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69182
License Number StateCA

VIII. Authorized Official

Name: MANJUL PATWARDHAN
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 408-725-1777