Provider Demographics
NPI:1093894552
Name:MANDANI, AMADO DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:AMADO
Middle Name:DAVID
Last Name:MANDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32026208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320260Medicaid
CAA32026Medicare ID - Type Unspecified
CA00A320260Medicaid