Provider Demographics
NPI:1598213316
Name:ANDREA MANN, DO, PMC
Entity type:Organization
Organization Name:ANDREA MANN, DO, PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:PARISA
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-215-1667
Mailing Address - Street 1:125 N ACACIA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1177
Mailing Address - Country:US
Mailing Address - Phone:858-215-1667
Mailing Address - Fax:858-724-1463
Practice Address - Street 1:125 N ACACIA AVE STE 107
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1177
Practice Address - Country:US
Practice Address - Phone:858-215-1667
Practice Address - Fax:858-724-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1311762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty