Healthcare Provider Details

I. General information

NPI: 1114004413
Provider Name (Legal Business Name): LOUIS ROBERT MANDRIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 LAWAI RD
KOLOA HI
96756-9666
US

IV. Provider business mailing address

5146 LAWAI RD
KOLOA HI
96756-9666
US

V. Phone/Fax

Practice location:
  • Phone: 213-393-9776
  • Fax:
Mailing address:
  • Phone: 213-393-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-22465
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: