Provider Demographics
NPI:1821218298
Name:RAMCHANDANI, MANISHA HARISH (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:HARISH
Last Name:RAMCHANDANI
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 SAWTELLE BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1616
Mailing Address - Country:US
Mailing Address - Phone:818-755-8000
Mailing Address - Fax:818-755-8006
Practice Address - Street 1:12157 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3204
Practice Address - Country:US
Practice Address - Phone:818-755-8000
Practice Address - Fax:818-755-8006
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71013FMedicaid