Provider Demographics
NPI:1831458280
Name:ARAVAGIRI, MANICKAM
Entity Type:Individual
Prefix:MR
First Name:MANICKAM
Middle Name:
Last Name:ARAVAGIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MANICKAM
Other - Middle Name:
Other - Last Name:ARAVAGIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:10261 KESSLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3511
Mailing Address - Country:US
Mailing Address - Phone:818-832-4553
Mailing Address - Fax:
Practice Address - Street 1:10261 KESSLER AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3511
Practice Address - Country:US
Practice Address - Phone:818-832-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist