Provider Demographics
NPI:1851454987
Name:MANTELL, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:MANTELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3311
Mailing Address - Country:US
Mailing Address - Phone:714-235-4502
Mailing Address - Fax:
Practice Address - Street 1:618 22ND ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-3311
Practice Address - Country:US
Practice Address - Phone:714-235-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39992207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39992OtherBLUE CROSS
00A399920OtherBLUE SHIELD
CA00A399920Medicaid
A39992OtherBLUE CROSS
00A399920Medicare ID - Type Unspecified
P00010583Medicare ID - Type UnspecifiedRAILROAD MEDICARE
00A399920OtherBLUE SHIELD
CA00A399925Medicare PIN