Basic Information
| Provider Information | |||||||||
| NPI: | 1568633170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHAPATRA | ||||||||
| FirstName: | DHARITRI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | ROOM C8-225 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250018 | ||||||||
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| Practice Location | |||||||||
| Address1: | 760 WESTWOOD PLZ | ||||||||
| Address2: | ROOM C8-225 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900245055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108250018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2008 | ||||||||
| LastUpdateDate: | 03/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD430610 | PA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | A93588 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
No ID Information.