Healthcare Provider Details

I. General information

NPI: 1881816122
Provider Name (Legal Business Name): HOLLARMANGAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 S DOBSON ROAD B221
MESA AZ
85202
US

IV. Provider business mailing address

1450 S DOBSON ROAD B221
MESA AZ
85202
US

V. Phone/Fax

Practice location:
  • Phone: 480-461-1161
  • Fax: 480-835-1482
Mailing address:
  • Phone: 480-461-1161
  • Fax: 480-835-1482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number27458
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number27458
License Number StateAZ

VIII. Authorized Official

Name: HEATHER MANGAM
Title or Position: OWNER
Credential: M.D.
Phone: 480-461-1161