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General NPI Number Information
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NPI Number | 1114981818
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Entity Type | Individual
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Provider Name | VANESSA JAIASHREE MANDAL MD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2110 PROFESSIONAL DRIVE SUITE 120
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City | ROSEVILLE
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State | CA
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Zip | 95661-0000
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Country | US
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Telephone | 916-536-2500
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Fax | 281-545-1442
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Provider Business Mailing Address
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Address Line | 3400 DATA DRIVE PHYSICIAN SUPPORT SERVICES
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone | 916-379-2948
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Fax | 916-858-7065
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M1435
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C55495
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License Number State | CA
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