Healthcare Provider Details

I. General information

NPI: 1336061589
Provider Name (Legal Business Name): MR. DHILIP MOHANAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7041 KOLL CENTER PKWY STE 210
PLEASANTON CA
94566-3189
US

IV. Provider business mailing address

25403 TAUPE AVE
MORENO VALLEY CA
92553-7169
US

V. Phone/Fax

Practice location:
  • Phone: 855-828-3200
  • Fax:
Mailing address:
  • Phone: 951-798-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: