Provider Demographics
NPI:1528140639
Name:KHATORE, MANOJ (MD)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:KHATORE
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 1:1901 OUTLET CENTER DR STE 260
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0667
Mailing Address - Country:US
Mailing Address - Phone:805-604-1824
Mailing Address - Fax:805-604-1844
Practice Address - Street 1:1901 OUTLET CENTER DR STE 260
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0667
Practice Address - Country:US
Practice Address - Phone:805-604-1824
Practice Address - Fax:805-604-1844
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A653480Medicaid
CAWA65348GMedicare PIN
CAWA65348FMedicare PIN
CABX730ZMedicare PIN
CAA65348Medicare PIN
CAWA65348DMedicare PIN
G84708Medicare UPIN