Provider Demographics
NPI:1851315196
Name:MANDELMAN, STEPHANIE J (M D)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:MANDELMAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:MANDELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M D
Mailing Address - Street 1:1250 LA VENTA DR
Mailing Address - Street 2:101B
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3702
Mailing Address - Country:US
Mailing Address - Phone:805-496-0880
Mailing Address - Fax:805-496-6670
Practice Address - Street 1:1250 LA VENTA DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3702
Practice Address - Country:US
Practice Address - Phone:805-496-0880
Practice Address - Fax:805-496-6670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68965OtherMEDICAL LICENSE