Healthcare Provider Details

I. General information

NPI: 1407731870
Provider Name (Legal Business Name): DONDRA MANDAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 VIA VERA CRUZ STE 255
SAN MARCOS CA
92078-2642
US

IV. Provider business mailing address

541 LEDGE ST
SAN MARCOS CA
92078-2840
US

V. Phone/Fax

Practice location:
  • Phone: 760-583-2524
  • Fax: 760-593-2430
Mailing address:
  • Phone: 760-583-2524
  • Fax: 760-593-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160334
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: