=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982799490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHIPAL S. CHAUDHRI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8770 CUYAMACA ST STE 4
-----------------------------------------------------
City | SANTEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92071-4289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-596-9890
-----------------------------------------------------
Fax | 619-596-9893
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 890 WESTFALL RD SUITE B
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14618-2610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-442-6960
-----------------------------------------------------
Fax | 585-442-3548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 196375
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 196375
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------