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General NPI Number Information
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NPI Number | 1093139792
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Entity Type | Organization
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Legal Business Name | RICHARD B MANTELL MD INC
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Dates
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Enumeration Date | 02/16/2014
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Last Update Date | 02/16/2014
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Provider Practice Location Address
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Address Line | 17822 BEACH BLVD SUITE 301
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7101
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Country | US
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Telephone | 714-794-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 17822 BEACH BLVD SUITE 301
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-7101
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Country | US
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Telephone | 714-794-6981
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD B MANTELL
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Credential | MD
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Telephone | 714-794-6981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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