Provider Demographics
NPI:1396333787
Name:MAHAPATRA, RHEA
Entity type:Individual
Prefix:
First Name:RHEA
Middle Name:
Last Name:MAHAPATRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2582
Mailing Address - Country:US
Mailing Address - Phone:800-478-8837
Mailing Address - Fax:707-551-3641
Practice Address - Street 1:100 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2582
Practice Address - Country:US
Practice Address - Phone:800-478-8837
Practice Address - Fax:707-551-3641
Is Sole Proprietor?:No
Enumeration Date:2021-01-02
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA190855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine