Healthcare Provider Details

I. General information

NPI: 1265467435
Provider Name (Legal Business Name): MOHAN PADAMANNUR RAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 TYLER AVENUE SUITE B
SOUTH EL MONTE CA
91733
US

IV. Provider business mailing address

114 S MARGUERITA AVE APT 2
ALHAMBRA CA
91801-3219
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-1560
  • Fax:
Mailing address:
  • Phone: 626-688-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA62446
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA62446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: