1124205331 NPI number — MRS. NITA C. MAHAJAN I MD

Table of content: MRS. NITA C. MAHAJAN I MD (NPI 1124205331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124205331 NPI number — MRS. NITA C. MAHAJAN I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHAJAN
Provider First Name:
NITA
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAHAJAN
Provider Other First Name:
NITA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, MPH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124205331
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12925 LOUISE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRANADA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91344-1076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-749-2300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12925 LOUISE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANADA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91344-1076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-749-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)