Provider Demographics
NPI:1659335420
Name:MANDEL, RONALD STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:STEVEN
Last Name:MANDEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3424
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:949-362-2121
Mailing Address - Fax:949-362-2110
Practice Address - Street 1:24502 PACIFIC PARK DR
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3043
Practice Address - Country:US
Practice Address - Phone:949-362-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX41490Medicaid
CA00AX4490Medicaid
CA20A4149Medicare ID - Type UnspecifiedMEDICARE
CAF48447Medicare UPIN