Provider Demographics
NPI:1245578772
Name:MANDI, ELDA
Entity Type:Individual
Prefix:
First Name:ELDA
Middle Name:
Last Name:MANDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 GOSHEN AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-7315
Mailing Address - Country:US
Mailing Address - Phone:310-473-7807
Mailing Address - Fax:
Practice Address - Street 1:12030 GOSHEN AVE
Practice Address - Street 2:APT. 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-7315
Practice Address - Country:US
Practice Address - Phone:310-473-7807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health