MEDICARE: MANSIMRAN KAUR MANDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1629505011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANSIMRAN KAUR MANDER

Provider Business Mailing Address
First Line	:	1430 ELM ST
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2072
Country	:	US
Telephone Number	:	916-388-4281
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 ELM ST
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95678-2072
Country	:	US
Telephone Number	:	916-388-4281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2017
Last Update Date	:	07/21/2022

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