Individual
KATHERINE ANN MANDEVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3020 CHILDRENS WAY, SAN DIEGO, CA 92123-4223
(858) 966-8036
(858) 966-7433
Mailing address
3020 CHILDRENS WAY # MC5003, SAN DIEGO, CA 92123-4223
(858) 309-6300
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
C149595
CA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
C149595
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22807349
—
CO
Enumeration date
10/25/2006
Last updated
07/21/2022
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