Provider Demographics
NPI:1780614065
Name:MALHOTRA, MANISHA (MD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
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:DEPT 34929
Mailing Address - Street 2:P.O. 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:1505 SAINT ALPHONSUS WAY
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:CA
Practice Address - Zip Code:94507-1570
Practice Address - Country:US
Practice Address - Phone:925-838-5750
Practice Address - Fax:925-838-5769
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00999672OtherRAILROAD MEDICARE
CA00A818100Medicaid
CA00A818100Medicaid
CACK102ZMedicare PIN