Provider Demographics
NPI:1285669267
Name:MANDEL, HILARY DIAMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:DIAMOND
Last Name:MANDEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11728 DOROTHY ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5560
Mailing Address - Country:US
Mailing Address - Phone:913-669-0582
Mailing Address - Fax:913-789-0914
Practice Address - Street 1:16111 PLUMMER ST.
Practice Address - Street 2:
Practice Address - City:SEPULVEDA
Practice Address - State:CA
Practice Address - Zip Code:91343
Practice Address - Country:US
Practice Address - Phone:818-891-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190475207N00000X
MDD0063455207N00000X
KS04-27711207N00000X
MO117321207N00000X
NJ59585207N00000X
CAG87885207N00000X
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG14893Medicare UPIN