| Usha Mantha Md Inc | |
|
1902 Royalty Dr Suite 200 Pomona CA 91767-3030 | |
| (909) 629-2290 | |
| Not Available |
| Full Name | Usha Mantha Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1902 Royalty Dr, Pomona, California |
| Authorized Official Name and Position | Usha Mantha (PRESIDENT) |
| Authorized Official Contact | 9096292290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Usha Mantha Md Inc 1902 Royalty Dr Suite 200 Pomona CA 91767-3030 Ph: (909) 629-2290 | Usha Mantha Md Inc 1902 Royalty Dr Suite 200 Pomona CA 91767-3030 Ph: (909) 629-2290 |
| NPI Number | 1922322551 |
|---|---|
| Provider Enumeration Date | 03/25/2010 |
| Last Update Date | 03/25/2010 |
| Medicare PECOS PAC ID | 0547391989 |
|---|---|
| Medicare Enrollment ID | O20100628001071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922322551 | NPI | - | NPPES |
| C52047 | Other | CA | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | C52047 (California) | Primary |
| Provider Name | Usha Mantha |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306806948 PECOS PAC ID: 2365341096 Enrollment ID: I20060123000916 |
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