Healthcare Provider Details

I. General information

NPI: 1124655899
Provider Name (Legal Business Name): AARTHI MANJUNATHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 3850
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-5293
  • Fax:
Mailing address:
  • Phone: 916-734-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A25823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: