Provider Demographics
NPI:1659411361
Name:MANTRI, DINESH S (MD)
Entity Type:Individual
Prefix:
First Name:DINESH
Middle Name:S
Last Name:MANTRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 991947
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1947
Mailing Address - Country:US
Mailing Address - Phone:530-768-4052
Mailing Address - Fax:844-424-9064
Practice Address - Street 1:3760 SUNLIGHT CT
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0173
Practice Address - Country:US
Practice Address - Phone:530-768-4052
Practice Address - Fax:844-424-9064
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23791ZMedicaid
CAZZZ23791ZMedicaid
E62296Medicare UPIN