Healthcare Provider Details

I. General information

NPI: 1215267307
Provider Name (Legal Business Name): ARAVIND CHANDRASHEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

16715 ALDERIDGE CT
RIVERSIDE CA
92503-9766
US

V. Phone/Fax

Practice location:
  • Phone: 866-984-7483
  • Fax:
Mailing address:
  • Phone: 713-751-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberBP20035707
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number137664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: