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General NPI Number Information
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NPI Number | 1124200506
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Entity Type | Organization
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Legal Business Name | WILLIAM MANDRICK, M.D., INC.
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 17310 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-3904
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Country | US
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Telephone | 818-728-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 44 HACKAMORE LN
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City | BELL CANYON
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State | CA
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Zip | 91307-1017
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Country | US
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Telephone | 818-716-1103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM MANDRICK
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Credential | MD
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Telephone | 818-728-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G83686
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License Number State | CA
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