Provider Demographics
NPI:1750466785
Name:MOHAPATRA, MEERABAI (MD)
Entity Type:Individual
Prefix:
First Name:MEERABAI
Middle Name:
Last Name:MOHAPATRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E VANDERBILT WAY MEDICAL STAFF OFFICE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-0001
Mailing Address - Country:US
Mailing Address - Phone:909-252-5149
Mailing Address - Fax:
Practice Address - Street 1:303 E VANDERBILT WAY MEDICAL STAFF OFFICE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0001
Practice Address - Country:US
Practice Address - Phone:909-252-5149
Practice Address - Fax:909-425-6635
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA841392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry