Provider Demographics
NPI:1912352774
Name:GAYTRI MANEK MD INC
Entity Type:Organization
Organization Name:GAYTRI MANEK MD INC
Other - Org Name:GAYTRI GANDOTRA MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYTRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-435-0150
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:STE 271
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-435-0150
Mailing Address - Fax:714-436-0126
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:STE 271
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-435-0150
Practice Address - Fax:714-436-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092700Medicaid