Provider Demographics
NPI:1598785198
Name:JEYAPALAN, MANJULA MAYURA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJULA
Middle Name:MAYURA
Last Name:JEYAPALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MANJULA
Other - Middle Name:MAYURA
Other - Last Name:JEYAPALAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15195 NATIONAL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2631
Mailing Address - Country:US
Mailing Address - Phone:408-356-7545
Mailing Address - Fax:408-356-7611
Practice Address - Street 1:15195 NATIONAL AVE
Practice Address - Street 2:STE 206
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2631
Practice Address - Country:US
Practice Address - Phone:408-356-7545
Practice Address - Fax:408-356-7611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74366208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA743660Medicare ID - Type Unspecified
CAH38773Medicare UPIN