Provider Demographics
NPI:1942536495
Name:ANMANGANDLA, DILIP (MD)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:
Last Name:ANMANGANDLA
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 1:28040 DOROTHY DRIVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-483-6334
Mailing Address - Fax:818-483-6345
Practice Address - Street 1:28040 DOROTHY DRIVE SUITE 103
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-483-6334
Practice Address - Fax:818-483-6345
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1195970Medicaid
CA00A1195970Medicaid