MEDICARE: CHANDRA S MOHANTY CP,BOCO,FAAOP

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	224P00000X	Prosthetist

General Provider Information

NPI Number	:	1801084843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA S MOHANTY CP,BOCO,FAAOP

Provider Business Mailing Address
First Line	:	1043 ELM AVE STE 202
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3244
Country	:	US
Telephone Number	:	562-432-2987
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SHADOW LN STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4355
Country	:	US
Telephone Number	:	702-800-6520
Fax Number	:	702-800-6492

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

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	03/09/2022

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Directions to “ CHANDRA S MOHANTY CP,BOCO,FAAOP” Practice Location

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