Healthcare Provider Details

I. General information

NPI: 1104859743
Provider Name (Legal Business Name): MANOHAR R.SENRA. M.D,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8337 TELEGRAPH RD SUITE#215
PICO RIVERA CA
90660-4909
US

IV. Provider business mailing address

8337 TELEGRAPH RD SUITE#215
PICO RIVERA CA
90660-4909
US

V. Phone/Fax

Practice location:
  • Phone: 562-927-6597
  • Fax: 562-927-0059
Mailing address:
  • Phone: 562-927-6597
  • Fax: 562-927-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA36780
License Number StateCA

VIII. Authorized Official

Name: MANOHAR R. SENRA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-927-6597