Healthcare Provider Details

I. General information

NPI: 1396005567
Provider Name (Legal Business Name): DR. ANANDHI MANDI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 NE BELKNAP CT SUITE # 202
HILLSBORO OR
97124-5113
US

IV. Provider business mailing address

PO BOX 97115
LAKEWOOD WA
98497-0115
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-4308
  • Fax:
Mailing address:
  • Phone: 253-588-7911
  • Fax: 253-984-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD22450
License Number StateOR

VIII. Authorized Official

Name: DR. ANANDHI MANDI
Title or Position: PROVIDER/OWNER
Credential: MD
Phone: 503-690-4308