MEDICARE: MS. LALI MANTHARAIL JOSEPH PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	316502	AZ

General Provider Information

NPI Number	:	1164307146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LALI MANTHARAIL JOSEPH PMHNP

Provider Business Mailing Address
First Line	:	693 W SAN CARLOS WAY
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-5173
Country	:	US
Telephone Number	:	602-300-2735
Fax Number	:

Provider Business Practice Location Address
First Line	:	693 W SAN CARLOS WAY
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-5173
Country	:	US
Telephone Number	:	602-300-2735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2025
Last Update Date	:	08/08/2025

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