Healthcare Provider Details

I. General information

NPI: 1710201413
Provider Name (Legal Business Name): AVNER MANZOOR MANDEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD SUITE # 512
BEVERLY HILLS CA
90210-5424
US

IV. Provider business mailing address

9301 WILSHIRE BLVD SUITE # 512
BEVERLY HILLS CA
90210-5424
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-2400
  • Fax: 310-271-0471
Mailing address:
  • Phone: 310-271-2400
  • Fax: 310-271-0471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: