Provider Demographics
NPI:1891947081
Name:ANEEL MANDAVA M D INC
Entity Type:Organization
Organization Name:ANEEL MANDAVA M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-631-8346
Mailing Address - Street 1:2323 16TH STREET
Mailing Address - Street 2:503
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3454
Mailing Address - Country:US
Mailing Address - Phone:661-631-8346
Mailing Address - Fax:661-631-8330
Practice Address - Street 1:2323 16TH STREET
Practice Address - Street 2:503
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3454
Practice Address - Country:US
Practice Address - Phone:661-631-8346
Practice Address - Fax:661-631-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA941752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty