Individual
MANI NALLASIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
424 E YOSEMITE AVE STE A, MERCED, CA 95340-8499
(209) 723-6882
(209) 723-6884
Mailing address
424 E YOSEMITE AVE STE A, MERCED, CA 95340-8499
(209) 723-6882
(209) 723-6884
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A44096
CA
207RC0001X
Clinical Cardiac Electrophysiology Physician
A44096
CA
207RI0011X
Interventional Cardiology Physician
A44096
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982977054
—
CA
01
—
A44096
LICENSE
CA
05
—
GR0043810
—
CA
Enumeration date
08/10/2005
Last updated
03/14/2019
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