Provider Demographics
NPI:1982803052
Name:MATTAI, NALINI DEVI (MD)
Entity Type:Individual
Prefix:
First Name:NALINI
Middle Name:DEVI
Last Name:MATTAI
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 1:301 S FAIR OAKS AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-792-1912
Mailing Address - Fax:626-792-1960
Practice Address - Street 1:301 S FAIR OAKS AVE STE 405
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-792-1912
Practice Address - Fax:626-792-1960
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83956208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG44771Medicare UPIN
CAWG83956CMedicare PIN