Individual
DR. STEPHEN LODOVICO MANDARO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8139 SUNSET AVE, SUITE 242, FAIR OAKS, CA 95628-5131
(916) 209-8505
(916) 967-1987
Mailing address
8139 SUNSET AVE, SUITE 242, FAIR OAKS, CA 95628-5131
(916) 209-8505
(916) 967-1987
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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