Healthcare Provider Details

I. General information

NPI: 1376390161
Provider Name (Legal Business Name): JAKARINYA MANGALAMOORTHY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR. RM. 714
MOBILE AL
36617
US

IV. Provider business mailing address

2451 UNIVERSITY HOSPITAL DR. RM. 714
MOBILE AL
36617
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7117
  • Fax:
Mailing address:
  • Phone: 251-471-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL.6378R
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL.6378R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: