Provider Demographics
NPI:1609844026
Name:MANGHNANI, REKHA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:REKHA
Middle Name:P
Last Name:MANGHNANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 906
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CA
Mailing Address - Zip Code:95368-0906
Mailing Address - Country:US
Mailing Address - Phone:209-577-9900
Mailing Address - Fax:209-577-1509
Practice Address - Street 1:2081 FOREST AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4841
Practice Address - Country:US
Practice Address - Phone:408-297-9949
Practice Address - Fax:408-297-9163
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87029208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87029OtherMED LIC