Provider Demographics
NPI:1356311211
Name:MALHOTRA, CHANDER P (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDER
Middle Name:P
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 SOQUEL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1769
Mailing Address - Country:US
Mailing Address - Phone:831-600-8860
Mailing Address - Fax:831-600-8118
Practice Address - Street 1:3540 SOQUEL AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1769
Practice Address - Country:US
Practice Address - Phone:831-600-8860
Practice Address - Fax:831-600-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35576207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A355760Medicaid
CAA88344Medicare UPIN
CA00A355762Medicare ID - Type Unspecified