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General NPI Number Information
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NPI Number | 1891130738
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Entity Type | Individual
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Provider Name | MAX RUBEN MANDELBAUM M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2624 EDITH AVE
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City | REDDING
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State | CA
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Zip | 96001-3043
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Country | US
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Telephone | 530-806-1190
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Fax | 530-229-7946
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Provider Business Mailing Address
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Address Line | 3400 DATA DR
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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 |
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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 | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | A155474
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License Number State | CA
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