Provider Demographics
NPI:1497097943
Name:MANDELLA, VIRGINIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:E
Last Name:MANDELLA
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 1:31361 MONTEREY ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6946
Mailing Address - Country:US
Mailing Address - Phone:949-499-2244
Mailing Address - Fax:
Practice Address - Street 1:31361 MONTEREY ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6946
Practice Address - Country:US
Practice Address - Phone:949-499-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51451207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology