Provider Demographics
NPI:1124086855
Name:NAYYAR, MANMOHAN (MD)
Entity type:Individual
Prefix:
First Name:MANMOHAN
Middle Name:
Last Name:NAYYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18523 CORWIN RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2300
Mailing Address - Country:US
Mailing Address - Phone:760-946-3876
Mailing Address - Fax:760-242-1936
Practice Address - Street 1:18523 CORWIN RD STE A
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2300
Practice Address - Country:US
Practice Address - Phone:760-946-3876
Practice Address - Fax:760-242-1936
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA422252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29535Medicare UPIN
CAZZZ27198ZMedicare ID - Type Unspecified