Provider Demographics
NPI:1346676426
Name:MANTENA, RAMACHANDRA RAJU
Entity Type:Individual
Prefix:
First Name:RAMACHANDRA
Middle Name:RAJU
Last Name:MANTENA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 MONTPELIER DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1612
Mailing Address - Country:US
Mailing Address - Phone:408-763-8099
Mailing Address - Fax:408-724-6599
Practice Address - Street 1:2324 MONTPELIER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1612
Practice Address - Country:US
Practice Address - Phone:408-763-8099
Practice Address - Fax:408-724-6599
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist