Provider Demographics
NPI:1497458251
Name:MANDOZA, MADELINE M (PA-C)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:M
Last Name:MANDOZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 S MAIN PL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-2427
Mailing Address - Country:US
Mailing Address - Phone:630-682-1950
Mailing Address - Fax:
Practice Address - Street 1:371 S MAIN PL
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-2427
Practice Address - Country:US
Practice Address - Phone:331-218-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant