Provider Demographics
NPI:1285148825
Name:MANDELL GORDEN, CAMI (RDN, CDE)
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:
Last Name:MANDELL GORDEN
Suffix:
Gender:F
Credentials:RDN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 HELEN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4025
Mailing Address - Country:US
Mailing Address - Phone:510-423-3039
Mailing Address - Fax:
Practice Address - Street 1:2835 HELEN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4025
Practice Address - Country:US
Practice Address - Phone:510-423-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1092669133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered