Provider Demographics
NPI:1710201413
Name:MANDEL, AVNER MANZOOR (MD)
Entity type:Individual
Prefix:DR
First Name:AVNER
Middle Name:MANZOOR
Last Name:MANDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE # 512
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5424
Mailing Address - Country:US
Mailing Address - Phone:310-271-2400
Mailing Address - Fax:310-271-0471
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:SUITE # 512
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5424
Practice Address - Country:US
Practice Address - Phone:310-271-2400
Practice Address - Fax:310-271-0471
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA37816Medicare UPIN