Healthcare Provider Details

I. General information

NPI: 1598659450
Provider Name (Legal Business Name): UMI CAITLIN CORONEL MANGUNE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 EAST ST
CONCORD CA
94520-2012
US

IV. Provider business mailing address

72 DEL PRADO CIR
FAIRFIELD CA
94533-1868
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-4224
  • Fax:
Mailing address:
  • Phone: 707-803-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: