Provider Demographics
NPI:1316472400
Name:MOHANASELVAN, ARVINDSELVAN (MD)
Entity type:Individual
Prefix:
First Name:ARVINDSELVAN
Middle Name:
Last Name:MOHANASELVAN
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 1:311 W I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3479
Mailing Address - Country:US
Mailing Address - Phone:209-826-2222
Mailing Address - Fax:
Practice Address - Street 1:311 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3479
Practice Address - Country:US
Practice Address - Phone:209-826-2222
Practice Address - Fax:209-827-9998
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2021-08-05
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-12-04
Provider Licenses
StateLicense IDTaxonomies
CAA171869207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine