Healthcare Provider Details

I. General information

NPI: 1699851303
Provider Name (Legal Business Name): CAROL ANNE WALKER & JOHN J MANGONI MDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 S ARROYO PKWY SUITE 420
PASADENA CA
91105
US

IV. Provider business mailing address

675 S ARROYO PKWY SUITE 420
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-0617
  • Fax:
Mailing address:
  • Phone: 626-795-0617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. GINNY BLAVEHARD
Title or Position: OFFICE MANAGER
Credential: OFFICE MANAGER
Phone: 626-795-0617