Healthcare Provider Details

I. General information

NPI: 1336725159
Provider Name (Legal Business Name): CHAKRI SANJEEV BILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHAKRAPANI PATHIKONDA MD

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W YOSEMITE AVE
MANTECA CA
95337-5130
US

IV. Provider business mailing address

2517 AMUR AVE
MANTECA CA
95337-8163
US

V. Phone/Fax

Practice location:
  • Phone: 209-824-5051
  • Fax:
Mailing address:
  • Phone: 800-994-0371
  • Fax: 254-215-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA205567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU9630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: