Provider Demographics
NPI:1265653836
Name:MANDILI, CARLA FARAH (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:FARAH
Last Name:MANDILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:349 E AVENUE K6 STE A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4548
Mailing Address - Country:US
Mailing Address - Phone:661-723-4260
Mailing Address - Fax:661-723-6975
Practice Address - Street 1:349 E AVENUE K6 STE A
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4548
Practice Address - Country:US
Practice Address - Phone:661-723-4260
Practice Address - Fax:661-723-6975
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA973852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry