Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | C52434 | CA |
N | 207RP1001X | Pulmonary Disease | C52434 | CA |
NPI | 1023006970 |
---|---|
Provider Name | Jess Mandel |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0246777 | (05) | IA |
42717 | WELLMARK BCBS (01) | IA |
G08769 | (02) |