NPIMap

Organization Active NPI

Steven L Mandel M D a Professional Corporation

Doing business as Ketamine Clinics of Los Angeles

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1366641722
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
STEVEN L MANDEL M D A PROFESSIONAL CORPORATION
Doing business as
Ketamine Clinics of Los Angeles
Practice address
6801 Park Ter Ste 525
Los Angeles, CA 90045-1543
Phone
(310) 270-0625
Fax
(310) 730-5993
NPI assigned
Jul 16, 2007
Last updated
Feb 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Samuel H Mandel
Title
Coo
Phone
(310) 270-0625

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G028631 CA
Anesthesiology Physician 207L00000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

6801 Park Ter Ste 525
Los Angeles, CA 90045-1543

Mailing address

6801 Park Ter Ste 525
Los Angeles, CA 90045-1543
Phone (310) 270-0625

Other identifiers 1

IdentifierTypeStateIssuer
00G286310MedicaidCA

Other names 1

  • Ketamine Clinics of Los Angeles Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080410000500 CA Part B Supplier - Clinic/Group Practice 9133206493 Receives reassigned benefits from 6 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

900 S Atlantic Blvd
Monterey Park, CA 91754
Phone (626) 457-7450

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1366641722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6801 PARK TER STE 525",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900451543",
            "telephone_number": "310-270-0625",
            "fax_number": "310-730-5993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6801 PARK TER STE 525",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900451543",
            "telephone_number": "310-270-0625",
            "fax_number": "310-730-5993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVEN L MANDEL M D A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-16",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "MANDEL",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "310-270-0625"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G028631",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G286310",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ketamine Clinics of Los Angeles",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.