Active NPI
Michael William Mandel
- Substance Abuse Rehabilitation Facility
- Fremont, CA
National Provider Identifier
1790924074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- License
- 010010AN
- Practice address
- 4510 Peralta Blvd Ste 1
Fremont, CA 94536-5755 - Phone
- (510) 713-3202
- Fax
- (510) 713-0684
- NPI assigned
- Feb 11, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | 010010AN | CA | Primary |
Addresses
Primary practice location
4510 Peralta Blvd Ste 1
Fremont, CA 94536-5755
Mailing address
4510 Peralta Blvd Ste 1
Fremont, CA 94536-5755
Phone (510) 713-3202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010010AN | CA | MD | Substance Abuse Rehabilitation Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234310400000",
"number": "1790924074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4510 PERALTA BLVD STE 1",
"city": "FREMONT",
"state": "CA",
"postal_code": "945365755",
"telephone_number": "510-713-3202",
"fax_number": "510-713-0684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 PERALTA BLVD STE 1",
"city": "FREMONT",
"state": "CA",
"postal_code": "945365755",
"telephone_number": "510-713-3202",
"fax_number": "510-713-0684"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDEL",
"first_name": "MICHAEL",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-11",
"last_updated": "2009-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": "CA",
"license": "010010AN",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.