Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | Q8104 | TX |
Y | 207QS0010X | Family Doctor - Sports Medicine | Q8104 | TX |
NPI | 1013352251 |
---|---|
Provider Name | Dr. Vincent Joseph Mandola |
First Address | Pearland, TX 77581-4305 |
Second Address | Pearland, TX 77581-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013352251 | NPI (01) | TX |