Provider Demographics
NPI:1629505011
Name:MANDER, MANSIMRAN KAUR
Entity Type:Individual
Prefix:
First Name:MANSIMRAN
Middle Name:KAUR
Last Name:MANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2072
Mailing Address - Country:US
Mailing Address - Phone:916-388-4281
Mailing Address - Fax:
Practice Address - Street 1:1430 ELM ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2072
Practice Address - Country:US
Practice Address - Phone:916-388-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician