1265415012 NPI number — MRS. ASHA MAHENDRA GANDHI M.D.

Table of content: MRS. ASHA MAHENDRA GANDHI M.D. (NPI 1265415012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265415012 NPI number — MRS. ASHA MAHENDRA GANDHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDHI
Provider First Name:
ASHA
Provider Middle Name:
MAHENDRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265415012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 DUNBLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-946-9652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 CALIFORNIA DRIVE
Provider Second Line Business Practice Location Address:
DEPT. OF MENTAL HEALTH, DEPT. OF CORRECTIONS
Provider Business Practice Location Address City Name:
VACAVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-449-6589
Provider Business Practice Location Address Fax Number:
707-453-7097
Provider Enumeration Date:
11/25/2005

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: 2084F0202X , with the licence number:  A034612 , 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)

  • Identifier: 0A346120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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