Provider Demographics
NPI:1841376589
Name:PURMANDLA, MAHENDER (MD; MPH)
Entity type:Individual
Prefix:
First Name:MAHENDER
Middle Name:
Last Name:PURMANDLA
Suffix:
Gender:M
Credentials:MD; MPH
Other - Prefix:
Other - First Name:MAHENDER
Other - Middle Name:
Other - Last Name:PURAMANDLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1592
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-0159
Mailing Address - Country:US
Mailing Address - Phone:650-496-6912
Mailing Address - Fax:
Practice Address - Street 1:39001 SUNDALE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2005
Practice Address - Country:US
Practice Address - Phone:650-476-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA883402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry