Provider Demographics
NPI:1568662385
Name:MANANDHI, ASWATHNARAYAN R (MD)
Entity Type:Individual
Prefix:
First Name:ASWATHNARAYAN
Middle Name:R
Last Name:MANANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASWATHNARAYAN
Other - Middle Name:RAGHAVENDRA
Other - Last Name:MANANDHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 S SAN VICENTE BLVD STE A3600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3311
Practice Address - Country:US
Practice Address - Phone:310-423-3977
Practice Address - Fax:310-423-6795
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050003207R00000X
CAA170306207RC0000X
ORMD211611207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500484 GROUPMedicaid
CT001500032Medicaid
CTD400052729 - C00814Medicare PIN
NVVWQBHV-GROUPMedicare PIN
NV100500484 GROUPMedicaid