Katherine Ann Mandeville

MD | Pediatric Emergency Medicine | Female

---

Complete Profile:

Katherine Ann Mandeville basic information including her official name, gender, specialization, credentials etc. are as mentioned below.

Specialization :	Pediatrics Pediatric Emergency Medicine
Provider Name :	Katherine Ann Mandeville
Credential :	MD
Gender :	Female

Business Address:

Katherine Ann Mandeville address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.

Primary Address :	3020 Childrens Way San Diego, CA, 92123-4223 United States
Phone Number :	858-966-8036
Fax Number :	858-966-7433

Professional Identification Codes:

NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.

NPI Number :	1649355397
NPI Entity Type :	Individual
First Enrolment Date :	25 Oct, 2006
Last Updated On :	21 Jul, 2022

Medicare Participation:

Katherine Ann Mandeville participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.

Medicare PECOS ID :	9638165202
Medicare Enrollment ID :	I20171025003518
Primary Specialty :	Emergency Medicine
Medical School :	University Of New Mexico School Of Medicine
Graduation Year :	1999
Accepts Medicare?	Yes. Katherine Ann Mandeville accepts medicare insurance.

Group Practice Association:

Katherine Ann Mandeville is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Katherine Ann Mandeville is associated with along with the number of members in that group. She may also accept medicare indirectly via these group practices.

Organisation Name :	Group Practice ID	No. of Members	Practice Address	Group Accepts Medicare
Rady Children's Hospital - San Diego	3971677493	120	3020 Childrens Way Mc 5069 Rady Children's Specialists San Diego, CA - 921234223 Ph: 8585761700	Yes

Licenses and Specialities:

Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Katherine Ann Mandeville are as mentioned. Primary taxonomy code for Katherine Ann Mandeville, MD is 2080P0204X (Pediatrics Pediatric Emergency Medicine).

Taxonomy Code	Speciality	Primary	License No.	State
2080P0204X	Pediatrics Pediatric Emergency Medicine	Yes	C149595	CA
208000000X	Pediatrics	No	C149595	CA

Legacy Identifiers:

Other legacy medical identifiers of Katherine Ann Mandeville such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.

Identifier	Identifier Type	State	Issuer
22807349	MEDICAID	CO

Mailing Address:

Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.

Mailing Address :	3020 Childrens Way # Mc5003 San Diego, CA, 92123-4223 United States
Phone Number :	858-309-6300

Business Location:

Patients can refer following map for directions to Katherine Ann Mandeville practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.