Provider Demographics
NPI:1912219197
Name:MANDADI, SWAPNA
Entity Type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:MANDADI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SWAPNA
Other - Middle Name:
Other - Last Name:MARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11608 TRAILBROOK LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6341
Mailing Address - Country:US
Mailing Address - Phone:858-486-7357
Mailing Address - Fax:
Practice Address - Street 1:12666 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4416
Practice Address - Country:US
Practice Address - Phone:858-486-0851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist