Provider Demographics
NPI:1215049374
Name:JOSHI, CHANDRASHEKHAR R (MD)
Entity type:Individual
Prefix:
First Name:CHANDRASHEKHAR
Middle Name:R
Last Name:JOSHI
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 1:1350 LOS ANGELES AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2898
Mailing Address - Country:US
Mailing Address - Phone:805-522-3782
Mailing Address - Fax:805-522-3873
Practice Address - Street 1:1350 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2898
Practice Address - Country:US
Practice Address - Phone:805-522-3782
Practice Address - Fax:805-522-3873
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255620Medicaid
W5213Medicare ID - Type Unspecified
CA00A255620Medicaid