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1134641087
KELLY MICHELE MANDA
ENCINO, CA
NPI
1134641087
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 95006929)
Enumeration Date
2017-07-12
Last Update Date
2017-07-12
Business Address
KELLY MICHELE MANDA FNP
5363 BALBOA BLVD STE 245
ENCINO, CA 91316-2827
Phone number: 818-343-4430
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Mailing Address
KELLY MICHELE MANDA FNP
3580 BUFFUM ST
SIMI VALLEY, CA 93063-3216
Phone number: 818-585-5428
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