Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | A34941 | CA |
NPI | 1184744658 |
---|---|
Provider Name | Dr. Manisha P Vichare |
First Address | Chico, CA 95929-0001 |
Second Address | Chico, CA 95929-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |