Provider Demographics
NPI:1336162817
Name:MANN, DEPINDER (MD)
Entity Type:Individual
Prefix:MISS
First Name:DEPINDER
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-744-5000
Mailing Address - Fax:714-744-5985
Practice Address - Street 1:555 N STATE COLLEGE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2900
Practice Address - Country:US
Practice Address - Phone:714-520-8470
Practice Address - Fax:714-520-8471
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine