Individual
ANEEL MANDAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 K ST, SUITE 502, SACRAMENTO, CA 95816-5120
(877) 515-0053
(916) 454-6926
Mailing address
10470 OLD PLACERVILLE RD, SUITE 100, SACRAMENTO, CA 95827-2539
(855) 771-0335
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A94175
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
A94175
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A941750
BLUE SHIELD
CA
05
—
00A941750
—
CA
01
—
1538143714
MEDI-CAL
CA
05
—
1538143714
—
CA
Enumeration date
12/01/2005
Last updated
07/09/2015
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