Provider Demographics
NPI:1942444005
Name:MANDELL, JUSTIN ABRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ABRAHAM
Last Name:MANDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD # SURGERY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-2680
Mailing Address - Fax:916-734-5633
Practice Address - Street 1:2315 STOCKTON BLVD # SURGERY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2680
Practice Address - Fax:916-734-5633
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1463102086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program