Organization
MANNIE JOEL MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SELENA M MAINARICK (OFFICE MANAGER)
(510) 278-0226
Entity
Organization
Contact information
Practice address
15035 E 14TH ST, SAN LEANDRO, CA 94578-1901
(510) 278-0226
(510) 278-5054
Mailing address
15035 E 14TH ST, SAN LEANDRO, CA 94578-1901
(510) 278-0226
(510) 278-5054
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
A34460
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A344600/1720043599
—
CA
Enumeration date
04/09/2009
Last updated
06/29/2010
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