Provider Demographics
NPI:1154410322
Name:ARAVAMUTHAN, MANJARI (MD)
Entity type:Individual
Prefix:
First Name:MANJARI
Middle Name:
Last Name:ARAVAMUTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 JOSE FIGUERES AVE
Mailing Address - Street 2:230
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1500
Mailing Address - Country:US
Mailing Address - Phone:408-929-6922
Mailing Address - Fax:408-929-8671
Practice Address - Street 1:200 JOSE FIGUERES AVE
Practice Address - Street 2:230
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1500
Practice Address - Country:US
Practice Address - Phone:408-929-6922
Practice Address - Fax:408-929-8671
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A620782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86564Medicare UPIN