Provider Demographics
NPI:1518279256
Name:MANN, ANDREA PARISA (DO)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PARISA
Last Name:MANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 N ACACIA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1177
Mailing Address - Country:US
Mailing Address - Phone:858-215-1667
Mailing Address - Fax:858-724-1463
Practice Address - Street 1:125 N ACACIA AVE STE 107
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1177
Practice Address - Country:US
Practice Address - Phone:858-215-1667
Practice Address - Fax:858-724-1463
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1311762084P0804X
CA20A127892084P0800X
CA20A 127892084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry