Organization Name: | SUSAN A MANDEL MD INC |
NPI Number: | 1801829353 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN ANN MANDEL (PRESIDENT) |
Mailing Address: | 150 N Robertson Blvd Suite 222 Beverly Hills |
State: | CA US |
Postal Code: | 902112144 |
Phone Number: | 3106524900 |
Fax Number: | 3106524902 |
NPI Enumeration Date: | 07/08/2006 |
NPI Last Update Date: | 09/10/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |