Provider Demographics
NPI:1659358794
Name:MANTENA, YOGITA (DO)
Entity Type:Individual
Prefix:
First Name:YOGITA
Middle Name:
Last Name:MANTENA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:YOGITA
Other - Middle Name:
Other - Last Name:KAPOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2941 LAKE VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3801
Mailing Address - Country:US
Mailing Address - Phone:972-899-6104
Mailing Address - Fax:972-899-7088
Practice Address - Street 1:9922 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1468
Practice Address - Country:US
Practice Address - Phone:346-206-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6651207P00000X
NY228403-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2556N1OtherBLUECROSS BLUESHIELD
NY02512765Medicaid
NY2556N1OtherBLUECROSS BLUESHIELD
NY02512765Medicaid