Healthcare Provider Details

I. General information

NPI: 1689784746
Provider Name (Legal Business Name): MANGAIRKARASIE POOPALAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANGA POOPALAN M.D.

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43839 15TH ST W
LANCASTER CA
93534-4756
US

IV. Provider business mailing address

PO BOX 7007
LANCASTER CA
93539-7007
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-5984
  • Fax: 661-951-3392
Mailing address:
  • Phone: 661-945-5984
  • Fax: 661-951-3392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41714
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: