Provider Demographics
NPI:1245237437
Name:MANDEL, HOWARD CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:CLAYTON
Last Name:MANDEL
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 1:10309 SANTA MONICA BLVD
Mailing Address - Street 2:# 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5007
Mailing Address - Country:US
Mailing Address - Phone:310-556-1427
Mailing Address - Fax:310-282-8567
Practice Address - Street 1:10309 SANTA MONICA BLVD
Practice Address - Street 2:# 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5007
Practice Address - Country:US
Practice Address - Phone:310-556-1427
Practice Address - Fax:310-282-8567
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48481207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92821Medicare UPIN