MEDICARE: DR. RONALD STEVEN MANDEL D.O.

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	207Q00000X	Family Medicine Physician	20A4149	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659335420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD STEVEN MANDEL D.O.

Provider Business Mailing Address
First Line	:	P.O. BOX 3424
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740
Country	:	US
Telephone Number	:	949-362-2121
Fax Number	:	949-362-2110

Provider Business Practice Location Address
First Line	:	24502 PACIFIC PARK DR
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3043
Country	:	US
Telephone Number	:	949-362-2121
Fax Number	:

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/16/2009

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