Healthcare Provider Details

I. General information

NPI: 1497246342
Provider Name (Legal Business Name): AL LIANDRO MAMARIL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 W CHILDS AVE
MERCED CA
95341-6862
US

IV. Provider business mailing address

230 W PARKSIDE DR
NEW CASTLE PA
16105-1080
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS021503
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT018280
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A23379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: