Provider Demographics
NPI:1093139792
Name:RICHARD B MANTELL MD INC
Entity Type:Organization
Organization Name:RICHARD B MANTELL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-794-6981
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7101
Mailing Address - Country:US
Mailing Address - Phone:714-794-6981
Mailing Address - Fax:
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-794-6981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-16
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty