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Organization
MICHAEL R. MANTELL, PH. D., INC
Active
Organization
MICHAEL R. MANTELL, PH. D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R. MANTELL PH.D. (CEO)
(619) 644-1111
Entity
Organization
Contact information
Practice address
5565 GROSSMONT CENTER DR, BLDG. 1- 223, LA MESA, CA 91942-3020
(619) 644-1111
(619) 644-1115
Mailing address
5565 GROSSMONT CENTER DR, BLDG. 1-223, LA MESA, CA 91942-3020
(619) 644-1111
(619) 644-1115
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY5020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2436992
AETNA
CA
Enumeration date
02/04/2011
Last updated
02/08/2011
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