Provider Demographics
NPI:1518925015
Name:MANI, PARVIN PAM (MD)
Entity Type:Individual
Prefix:
First Name:PARVIN
Middle Name:PAM
Last Name:MANI
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 1:5555 RESERVOIR DR, STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-583-7555
Mailing Address - Fax:619-583-0555
Practice Address - Street 1:5555 RESERVOIR DR, STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-583-7555
Practice Address - Fax:619-583-0555
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52580207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A525800Medicaid
CAA52580Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
G59938Medicare UPIN