Healthcare Provider Details

I. General information

NPI: 1679874879
Provider Name (Legal Business Name): ALAN MANTELL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 VERDUGO BLVD SUITE 304
GLENDALE CA
91208-1403
US

IV. Provider business mailing address

1818 VERDUGO BLVD SUITE 304
GLENDALE CA
91208-1403
US

V. Phone/Fax

Practice location:
  • Phone: 818-790-3588
  • Fax: 818-790-6518
Mailing address:
  • Phone: 818-790-3588
  • Fax: 818-790-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG18862
License Number StateCA

VIII. Authorized Official

Name: ALAN MANTELL
Title or Position: OWNER
Credential: M.D.
Phone: 818-790-3588