Provider Demographics
NPI:1790777308
Name:MANOHAR, NAVEEN S (MD)
Entity Type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:S
Last Name:MANOHAR
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 1:2929 K ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5122
Mailing Address - Country:US
Mailing Address - Phone:916-750-8113
Mailing Address - Fax:916-710-8113
Practice Address - Street 1:2929 K ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5122
Practice Address - Country:US
Practice Address - Phone:916-750-8113
Practice Address - Fax:916-710-8113
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA889772080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A88977Medicaid
CAZZZ00672ZMedicare ID - Type Unspecified
CA00A88977Medicaid