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General NPI Number Information
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NPI Number | 1013223601
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Entity Type | Organization
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Legal Business Name | S AVA MAHAPATRA MD A PROF CORPORATION
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 1180 N INDIAN CANYON DR SUITE W-210
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4800
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Country | US
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Telephone | 760-323-2225
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Fax | 760-323-1147
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Provider Business Mailing Address
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Address Line | 1180 N INDIAN CANYON DR SUITE W-210
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4800
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Country | US
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Telephone | 760-323-2225
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Fax | 760-323-1147
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHAKTI AVA MAHAPATRA
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Credential | M.D.
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Telephone | 760-323-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A37578
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License Number State | CA
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