Individual
BOSE MANDAVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 NORTH 10TH STREET, SANTA PAULA, CA 93060
(805) 933-8600
(805) 933-8664
Mailing address
3418 LOMA VISTA RD, SUITE A, VENTURA, CA 93003
(805) 642-8565
(805) 642-8564
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C51112
CA
207L00000X
Anesthesiology Physician
C5112
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C511120
—
CA
Enumeration date
01/25/2007
Last updated
08/01/2008
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