Organization
MANDEGAR MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MEHRAN MANDEGAR MD (OWNER)
(888) 664-8297
Entity
Organization
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(888) 664-8297
(801) 650-6861
Mailing address
PO BOX 26940, SAN DIEGO, CA 92196-0940
(888) 664-8297
(801) 650-6861
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A63770
CA
207RP1001X
Pulmonary Disease Physician
Primary
A63770
CA
208M00000X
Hospitalist Physician
A63770
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1911036
—
CA
Enumeration date
08/12/2016
Last updated
08/12/2016
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