MEDICARE: DR. ALAN IRVING MANDELBERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G39019	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659422582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN IRVING MANDELBERG M.D.

Provider Business Mailing Address
First Line	:	4418 VINELAND AVE
Second Line	:	106
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3457
Country	:	US
Telephone Number	:	818-762-0647
Fax Number	:	818-762-7834

Provider Business Practice Location Address
First Line	:	4418 VINELAND AVE
Second Line	:	#106
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-3457
Country	:	US
Telephone Number	:	818-762-0647
Fax Number	:	818-762-7834

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	04/22/2008

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