Healthcare Provider Details

I. General information

NPI: 1538694088
Provider Name (Legal Business Name): MANOHAR SUKUMAR JD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W CIVIC CENTER DR 601 CIVIC CENTER DRIVE WEST
SANTA ANA CA
92701-4002
US

IV. Provider business mailing address

601 W CIVIC CENTER DR PUBLIC LAW CENTER, ATTN: MANOHAR SUKUMAR
SANTA ANA CA
92701-4002
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-1010
  • Fax: 714-541-5157
Mailing address:
  • Phone: 714-541-1010
  • Fax: 714-541-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number289926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: