Healthcare Provider Details

I. General information

NPI: 1063933778
Provider Name (Legal Business Name): RACHANA MANDRU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S 30TH AVE STE 101
YAKIMA WA
98902-3713
US

IV. Provider business mailing address

231 ALBERT SABIN WAY
CINCINNATI OH
45267-0564
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-7715
  • Fax:
Mailing address:
  • Phone: 513-558-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD61364540
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD6136450
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: