Healthcare Provider Details

I. General information

NPI: 1861501025
Provider Name (Legal Business Name): MANI NAMBIAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BUENA VISTA ST
HEMET CA
92543-4308
US

IV. Provider business mailing address

130 S BUENA VISTA ST
HEMET CA
92543-4308
US

V. Phone/Fax

Practice location:
  • Phone: 951-766-2760
  • Fax: 951-929-5333
Mailing address:
  • Phone: 951-766-2760
  • Fax: 951-929-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA40026
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: