Provider Demographics
NPI:1154451417
Name:MANDELBERG, JOSHUA HUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:HUGH
Last Name:MANDELBERG
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 1:11835 W OLYMPIC BLVD STE 1200E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5801
Mailing Address - Country:US
Mailing Address - Phone:310-996-8990
Mailing Address - Fax:310-996-8991
Practice Address - Street 1:11835 W OLYMPIC BLVD STE 1200E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5801
Practice Address - Country:US
Practice Address - Phone:310-996-8990
Practice Address - Fax:310-996-8991
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics