Provider Demographics
NPI:1124298237
Name:MANEK, GAYTRI (MD)
Entity type:Individual
Prefix:
First Name:GAYTRI
Middle Name:
Last Name:MANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYTRI
Other - Middle Name:
Other - Last Name:GANDOTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:SUITE 271
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
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:SUITE 271
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-435-0150
Practice Address - Fax:714-436-0126
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106569207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0092700Medicaid