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General NPI Number Information
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NPI Number | 1295830974
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Entity Type | Organization
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Legal Business Name | DR MAHADEV MD INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 CHAPARRAL COURT SUITE 102
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City | ANAHEIM HILLS
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State | CA
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Zip | 92808
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Country | US
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Telephone | 714-998-1941
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Fax | 714-998-3472
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Provider Business Mailing Address
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Address Line | 125 CHAPARRAL COURT SUITE 102
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City | ANAHEIM HILLS
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State | CA
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Zip | 92808
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Country | US
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Telephone | 714-998-1941
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Fax | 714-998-3472
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Authorized Official
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Title or Position | MD
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Name | MR. MARIGANGAIAH MAHADEV
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Credential | MD
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Telephone | 714-998-1941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | CA
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