Healthcare Provider Details

I. General information

NPI: 1265354179
Provider Name (Legal Business Name): MIRANDA MANGAHAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 SUNRISE BLVD STE A
GOLD RIVER CA
95670-4344
US

IV. Provider business mailing address

601 ORE CART CT
EL DORADO HILLS CA
95762-6614
US

V. Phone/Fax

Practice location:
  • Phone: 916-642-1867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95040720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: