Healthcare Provider Details

I. General information

NPI: 1588618409
Provider Name (Legal Business Name): PRABHAT S MANCHANDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 VIA CAMPO
MONTEBELLO CA
90640-1807
US

IV. Provider business mailing address

2601 VIA CAMPO
MONTEBELLO CA
90640-1807
US

V. Phone/Fax

Practice location:
  • Phone: 323-720-1144
  • Fax: 323-837-7231
Mailing address:
  • Phone: 323-720-1144
  • Fax: 323-837-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA33788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: