Individual
BENJAMIN REYES MANDAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
710 LAWRENCE EXPY, SANTA CLARA, CA 95051-5173
(408) 851-5000
Mailing address
1558 GUADALAJARA DR, SAN JOSE, CA 95120-4814
(408) 833-5129
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
G55790
CA
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
G55790
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G557900
—
CA
Enumeration date
04/21/2006
Last updated
08/15/2024
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