Provider Demographics
NPI:1629477344
Name:MANDAP, LEE BELLA ABUAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:LEE BELLA
Middle Name:ABUAN
Last Name:MANDAP
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 MASTERS ST
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:95758
Mailing Address - Country:PH
Mailing Address - Phone:916-897-7321
Mailing Address - Fax:
Practice Address - Street 1:69175 RAMON RD BLDG A
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3344
Practice Address - Country:US
Practice Address - Phone:760-321-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000984363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner