Individual
MR. SADIQ MANDILAWI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1234 FOOTHILL BLVD, LA VERNE, CA 91750-3329
(909) 596-4879
(909) 596-9199
Mailing address
1234 FOOTHILL BLVD, LA VERNE, CA 91750-3329
(909) 596-4879
(909) 596-9199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A34207
CA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
A34207
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A342070
—
CA
01
—
CB220525
PTAN
CA
Enumeration date
11/10/2005
Last updated
03/28/2017
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