Provider Demographics
NPI:1891130738
Name:MANDELBAUM, MAX RUBEN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:RUBEN
Last Name:MANDELBAUM
Suffix:
Gender:M
Credentials:MD, PHD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2624 EDITH AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-3043
Practice Address - Country:US
Practice Address - Phone:530-806-1190
Practice Address - Fax:530-229-7946
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2024-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1554742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology