Provider Demographics
NPI:1093859423
Name:AVNER MANZOOR MANDEL M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:AVNER MANZOOR MANDEL M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AVNER
Authorized Official - Middle Name:MANZOOR
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-644-5353
Mailing Address - Street 1:4477 W 118TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2258
Mailing Address - Country:US
Mailing Address - Phone:310-644-5353
Mailing Address - Fax:
Practice Address - Street 1:4477 W 118TH ST STE 302
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2258
Practice Address - Country:US
Practice Address - Phone:310-644-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37816174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37816Medicare UPIN