Individual
IRVAN MANDALAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
330 MOSS ST, CHULA VISTA, CA 91911-2005
(619) 585-4221
Mailing address
330 MOSS ST, CHULA VISTA, CA 91911-2005
(619) 585-4221
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95249444
CA
Other
Enumeration date
01/12/2024
Last updated
01/12/2024
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