Provider Demographics
NPI:1407932395
Name:MANDELBAUM, DANIEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:P
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:216 W PERKINS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4800
Mailing Address - Country:US
Mailing Address - Phone:707-462-1640
Mailing Address - Fax:707-462-1640
Practice Address - Street 1:216 W PERKINS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4800
Practice Address - Country:US
Practice Address - Phone:707-462-1640
Practice Address - Fax:707-462-1640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG210732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G21073020Medicaid
CAA41168Medicare UPIN