Mamie Mukundi Mandela, NURSE PRACTITIONER

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

95010871 Issued in CA

Practice address

1413 E 218TH St
Carson, CA 90745-2402

Phone

(310) 702-5392

Fax

(310) 518-2585

NPI assigned

Dec 21, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1545350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560470400000",
    "number": "1831661370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1413 E 218TH ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452402",
            "telephone_number": "310-702-5392",
            "fax_number": "310-518-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1413 E 218TH ST",
            "city": "CARSON",
            "state": "CA",
            "postal_code": "907452402",
            "telephone_number": "310-702-5392",
            "fax_number": "310-518-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDELA",
        "first_name": "MAMIE",
        "middle_name": "MUKUNDI",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-21",
        "last_updated": "2019-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95010871",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95010871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amber Makar, LCSW
• Alexandria Maldonado
• Sean Thomas Malone Sr., RADT
• Teresa R Malone
• Mammo Q Plus Inc
• Kara Manders
• Manio Vision Center, Inc
• Seraphim C Manio, O.D.
• Ciara Manning
• Estefani Natalia Mantanico

• Primary Care Nurse Practitioner in Carson, CA
• Providers in Carson, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.