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1073722260
KELLY C MANDAVIA
LOS ANGELES, CA
NPI
1073722260
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: CA PA14661)
Enumeration Date
2007-05-22
Last Update Date
2007-07-08
Business Address
-- KELLY C MANDAVIA MD
4650 W SUNSET BLVD MS# 54
LOS ANGELES, CA 90027-6062
Phone number: 323-669-5653
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Mailing Address
-- KELLY C MANDAVIA MD
6430 W SUNSET BLVD SUITE 600
LOS ANGELES, CA 90028-7901
Phone number: 323-669-2337
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