Provider Demographics
NPI:1033244348
Name:ANOOP MAHESHWARI M.D PROF. CORP.
Entity Type:Organization
Organization Name:ANOOP MAHESHWARI M.D PROF. CORP.
Other - Org Name:ANOOP MAHESHWARI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LECHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-808-0954
Mailing Address - Street 1:1157 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4364
Mailing Address - Country:US
Mailing Address - Phone:951-737-5809
Mailing Address - Fax:951-848-6923
Practice Address - Street 1:1175 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4393
Practice Address - Country:US
Practice Address - Phone:951-737-5809
Practice Address - Fax:951-848-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045841174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A458411Medicaid
CA05D09393966OtherCLIA
CABM1992672OtherDEA
CABM1992672OtherDEA
CAF57130Medicare UPIN