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Individual

DR. STEPHEN LODOVICO MANDARO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
G50320
CA
208D00000X
General Practice Physician
G50320
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7664031
CA
Enumeration date
01/18/2010
Last updated
01/18/2010
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