Provider Demographics
NPI:1932858297
Name:GOVINDARAM, MANJU BHARGAVI (MBBS)
Entity Type:Individual
Prefix:DR
First Name:MANJU BHARGAVI
Middle Name:
Last Name:GOVINDARAM
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:MANJU BHARGAVI
Other - Middle Name:
Other - Last Name:JONNOJI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:4802 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2916
Mailing Address - Country:US
Mailing Address - Phone:718-283-6000
Mailing Address - Fax:718-635-7484
Practice Address - Street 1:3939 BIDWELL DR APT 511
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2351
Practice Address - Country:US
Practice Address - Phone:510-598-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program