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General NPI Number Information
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NPI Number | 1801084843
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Entity Type | Individual
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Provider Name | CHANDRA S MOHANTY CP,BOCO,FAAOP
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Gender | Male
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 400 SHADOW LN STE 110
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City | LAS VEGAS
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State | NV
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Zip | 89106-4355
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Country | US
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Telephone | 702-800-6520
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Fax | 702-800-6492
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Provider Business Mailing Address
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Address Line | 1043 ELM AVE STE 202
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City | LONG BEACH
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State | CA
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Zip | 90813-3244
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Country | US
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Telephone | 562-432-2987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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