Provider Demographics
NPI:1457850455
Name:MANJARI ARAVAMUTHAN,M.D.;P.C.
Entity Type:Organization
Organization Name:MANJARI ARAVAMUTHAN,M.D.;P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT&CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MANJARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAVAMUTHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-929-6922
Mailing Address - Street 1:PO BOX 3217
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95156-3217
Mailing Address - Country:US
Mailing Address - Phone:408-929-6922
Mailing Address - Fax:408-929-8671
Practice Address - Street 1:1569 LEXANN AVE STE 220
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1795
Practice Address - Country:US
Practice Address - Phone:408-929-6922
Practice Address - Fax:408-929-8671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty