Provider Demographics
NPI:1184234544
Name:MANDELLO, KARINA (BS)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:MANDELLO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KARINA
Other - Middle Name:
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8250 N GRAND CANYON DR UNIT 2121
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-3734
Mailing Address - Country:US
Mailing Address - Phone:818-689-3278
Mailing Address - Fax:
Practice Address - Street 1:8250 N GRAND CANYON DR UNIT 2121
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-3734
Practice Address - Country:US
Practice Address - Phone:818-689-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner