Provider Demographics
NPI:1770246795
Name:MANDAP, JASON LIANG (FNP-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LIANG
Last Name:MANDAP
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3003
Mailing Address - Country:US
Mailing Address - Phone:323-773-8295
Mailing Address - Fax:
Practice Address - Street 1:6517 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-3003
Practice Address - Country:US
Practice Address - Phone:323-773-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily