Healthcare Provider Details

I. General information

NPI: 1609844026
Provider Name (Legal Business Name): REKHA P MANGHNANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 FOREST AVE SUITE #2
SAN JOSE CA
95128-4841
US

IV. Provider business mailing address

PO BOX 906
SALIDA CA
95368-0906
US

V. Phone/Fax

Practice location:
  • Phone: 408-297-9949
  • Fax: 408-297-9163
Mailing address:
  • Phone: 209-577-9900
  • Fax: 209-577-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: