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General NPI Number Information
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NPI Number | 1063977270
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Entity Type | Individual
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Provider Name | AISHAH MANDEEL NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 14971 HOLT AVE
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City | TUSTIN
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State | CA
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Zip | 92780-3406
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Country | US
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Telephone | 949-356-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 13446 WARREN PL
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City | VICTORVILLE
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State | CA
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Zip | 92395-8660
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95011055
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License Number State | CA
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