Provider Demographics
NPI:1588792956
Name:MANDEL, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9744 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1814
Mailing Address - Country:US
Mailing Address - Phone:310-276-0077
Mailing Address - Fax:310-276-8450
Practice Address - Street 1:9744 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 410
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1814
Practice Address - Country:US
Practice Address - Phone:310-276-0077
Practice Address - Fax:310-276-8450
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG-11638174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist