Provider Demographics
NPI:1578599791
Name:MAHAMITRA, WALCHAREE CINDY (DO)
Entity Type:Individual
Prefix:DR
First Name:WALCHAREE
Middle Name:CINDY
Last Name:MAHAMITRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5679
Mailing Address - Country:US
Mailing Address - Phone:310-221-6375
Mailing Address - Fax:310-829-6352
Practice Address - Street 1:1821 WILSHIRE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5679
Practice Address - Country:US
Practice Address - Phone:310-221-6375
Practice Address - Fax:310-829-6352
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15847Medicare UPIN