Healthcare Provider Details

I. General information

NPI: 1558275024
Provider Name (Legal Business Name): BILLY MANDAP RT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22187 SILVERBELL LN
MORENO VALLEY CA
92553-6927
US

IV. Provider business mailing address

22187 SILVERBELL LN
MORENO VALLEY CA
92553-6927
US

V. Phone/Fax

Practice location:
  • Phone: 480-305-6132
  • Fax: 561-423-0844
Mailing address:
  • Phone: 480-305-6132
  • Fax: 561-423-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number39834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: