KATHERINE ANN MANDEVILLE MD NPI 1649355397

NPI Information

NPI: 1649355397
Provider Name: KATHERINE ANN MANDEVILLE, MD
Classification: Pediatrics - 2080P0204X
Entity Type: Individual

Specialization: Pediatric Emergency Medicine

PECOS Registration: Yes

Address:
3020 CHILDRENS WAY
SAN DIEGO, CA
ZIP 92123
Phone: (858) 966-8036
Get Directions

Katherine Ann Mandeville, MD is a pediatric emergency medicine pediatrics in San Diego, CA. The provider is a pediatrician who has special qualifications to manage emergencies in infants and children. Katherine Ann Mandeville, MD NPI is 1649355397. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3020 CHILDRENS WAY
SAN DIEGO, CA
ZIP 92123-223
Phone: (858) 966-8036
Fax: (858) 966-7433

The NPI 1649355397 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/25/2006 and was last updated on 7/21/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080P0204X	Pediatrics	Pediatric Emergency Medicine	C149595	CALIFORNIA	Yes
2	208000000X	Pediatrics		C149595	CALIFORNIA	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	22807349	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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