Provider Demographics
NPI:1356074009
Name:MAMAC, PAUL ANDREI
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREI
Last Name:MAMAC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 OAKWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3569
Mailing Address - Country:US
Mailing Address - Phone:747-218-8594
Mailing Address - Fax:
Practice Address - Street 1:3455 PERCY ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1716
Practice Address - Country:US
Practice Address - Phone:323-268-2100
Practice Address - Fax:323-983-7530
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program