Provider Demographics
NPI:1053587832
Name:AMADO D. MANDANI M.D.,INC.
Entity type:Organization
Organization Name:AMADO D. MANDANI M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMADO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-962-7886
Mailing Address - Street 1:14338 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3241
Mailing Address - Country:US
Mailing Address - Phone:626-962-7886
Mailing Address - Fax:626-962-4636
Practice Address - Street 1:14338 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3241
Practice Address - Country:US
Practice Address - Phone:626-962-7886
Practice Address - Fax:626-962-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32026207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320260Medicaid
CA00A320260Medicaid
CAA32026Medicare PIN