Provider Demographics
NPI:1275690653
Name:PANDEY, MANIKA (MD)
Entity Type:Individual
Prefix:
First Name:MANIKA
Middle Name:
Last Name:PANDEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 K ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2737
Mailing Address - Country:US
Mailing Address - Phone:760-344-9951
Mailing Address - Fax:
Practice Address - Street 1:91275 66TH AVE
Practice Address - Street 2:500
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254
Practice Address - Country:US
Practice Address - Phone:760-396-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine