Healthcare Provider Details

I. General information

NPI: 1598213316
Provider Name (Legal Business Name): ANDREA MANN, DO, PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N ACACIA AVE STE 107
SOLANA BEACH CA
92075-1177
US

IV. Provider business mailing address

125 N ACACIA AVE STE 107
SOLANA BEACH CA
92075-1177
US

V. Phone/Fax

Practice location:
  • Phone: 858-215-1667
  • Fax: 858-724-1463
Mailing address:
  • Phone: 858-215-1667
  • Fax: 858-724-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ANDREA MANN
Title or Position: PHYSICIAN
Credential: DO
Phone: 858-215-1667