Provider Demographics
NPI:1609024959
Name:MANDLHATE, LOIDE
Entity type:Individual
Prefix:
First Name:LOIDE
Middle Name:
Last Name:MANDLHATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOIDE
Other - Middle Name:
Other - Last Name:HUMBANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:380 ENCINAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2178
Mailing Address - Country:US
Mailing Address - Phone:831-469-1700
Mailing Address - Fax:
Practice Address - Street 1:106 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4709
Practice Address - Country:US
Practice Address - Phone:831-761-5422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91892ZOtherMEDICARE GROUP PTAN#
CAZZZ92069ZOtherMEDICARE GROUP PTAN#
CAZZZ91891ZOtherMEDICARE GROUP PTAN#