Provider Demographics
NPI:1609044288
Name:DAN A. MANDEL, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAN A. MANDEL, M.D., A MEDICAL CORPORATION
Other - Org Name:ARTHRITIS & RHEUMATOLOGY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:AVIEL
Authorized Official - Last Name:MANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-853-6694
Mailing Address - Street 1:1835 NEWPORT BLVD
Mailing Address - Street 2:A109-437
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5031
Mailing Address - Country:US
Mailing Address - Phone:949-631-6500
Mailing Address - Fax:
Practice Address - Street 1:496 OLD NEWPORT BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4263
Practice Address - Country:US
Practice Address - Phone:949-631-6500
Practice Address - Fax:949-631-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88439207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty