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General NPI Number Information
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NPI Number | 1194449835
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Entity Type | Individual
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Provider Name | MANDI BARTELLE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 11340 W OLYMPIC BLVD STE 120
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City | LOS ANGELES
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State | CA
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Zip | 90064-1611
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Country | US
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Telephone | 805-223-3615
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Fax |
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Provider Business Mailing Address
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Address Line | 1297 CYPRESS POINT LN APT 103
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City | VENTURA
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State | CA
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Zip | 93003-6095
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Country | US
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Telephone | 805-223-3615
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 19536
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License Number State | CA
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