Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | G33195 | CA |
NPI | 1306946926 |
---|---|
Provider Name | Dr. Mark Alan Mandelkern |
First Address | Pacific Palisades, CA 90272-4450 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |