Provider Demographics
NPI:1467744466
Name:STEPHANIE J MANDELMAN M D INC
Entity Type:Organization
Organization Name:STEPHANIE J MANDELMAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D INC
Authorized Official - Phone:805-496-0880
Mailing Address - Street 1:1250 LA VENTA DR
Mailing Address - Street 2:101B
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3702
Mailing Address - Country:US
Mailing Address - Phone:805-496-0880
Mailing Address - Fax:805-496-6670
Practice Address - Street 1:1250 LA VENTA DR
Practice Address - Street 2:101B
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3702
Practice Address - Country:US
Practice Address - Phone:805-496-0880
Practice Address - Fax:805-496-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68965OtherMEDICAL LICENSE