Provider Demographics
NPI:1750575296
Name:SENRA, MANOHAR R (MD)
Entity type:Individual
Prefix:
First Name:MANOHAR
Middle Name:R
Last Name:SENRA
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 1:8337 TELEGRAPH RD
Mailing Address - Street 2:SUITE#215
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4909
Mailing Address - Country:US
Mailing Address - Phone:562-927-6597
Mailing Address - Fax:562-927-0059
Practice Address - Street 1:8337 TELEGRAPH RD
Practice Address - Street 2:SUITE#215
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4909
Practice Address - Country:US
Practice Address - Phone:562-927-6597
Practice Address - Fax:562-927-0059
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36780207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A367800Medicaid
CAA28180Medicare UPIN
CAA36780Medicare PIN