Provider Demographics
NPI:1114930377
Name:MANOHAR R SENRA MD, INC
Entity Type:Organization
Organization Name:MANOHAR R SENRA MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOHAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:SENRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-927-6597
Mailing Address - Street 1:8337 TELEGRAPH ROAD
Mailing Address - Street 2:SUITE #215
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4945
Mailing Address - Country:US
Mailing Address - Phone:562-927-6597
Mailing Address - Fax:562-927-0059
Practice Address - Street 1:8337 TELEGRAPH ROAD
Practice Address - Street 2:SUITE #215
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4945
Practice Address - Country:US
Practice Address - Phone:562-927-6597
Practice Address - Fax:562-927-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36780207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A367800Medicaid
A28180Medicare UPIN
CA00A367800Medicaid