Provider Demographics
NPI:1588859532
Name:MONTEREY MEDICAL CENTER
Entity Type:Organization
Organization Name:MONTEREY MEDICAL CENTER
Other - Org Name:MONTEREY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-642-6266
Mailing Address - Street 1:100 WILSON RD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-642-6266
Mailing Address - Fax:831-642-9244
Practice Address - Street 1:100 WILSON RD.
Practice Address - Street 2:SUITE 110
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7885
Practice Address - Country:US
Practice Address - Phone:831-642-6266
Practice Address - Fax:831-642-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03111ZOtherPTAN
ZZZ03111ZOtherPTAN
ZZZ03111ZOtherPTAN
CA=========OtherTAX ID