Provider Demographics
NPI:1205802618
Name:MANIAM, AJIT S (MD)
Entity type:Individual
Prefix:DR
First Name:AJIT
Middle Name:S
Last Name:MANIAM
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 1:1801 W ROMNEYA DR
Mailing Address - Street 2:STE 203
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1824
Mailing Address - Country:US
Mailing Address - Phone:714-999-1465
Mailing Address - Fax:714-999-1701
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:STE#203
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1830
Practice Address - Country:US
Practice Address - Phone:714-999-1465
Practice Address - Fax:714-999-1701
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA56120OtherCOMMERICAL
CA00A56120Medicaid
CA00A56120Medicaid
CAWA56120Medicare PIN