Individual
SALLY M MANDICHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
740 CALIFORNIA AVE, RENO, NV 89509
(775) 233-5300
Mailing address
200 MERCY CIRCLE OCEANSIDE, OCEANSIDE, CA 92055
(775) 233-5300
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101267386
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/12/2017
Last updated
12/04/2023
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