Healthcare Provider Details

I. General information

NPI: 1275463663
Provider Name (Legal Business Name): NORMINIO MANGABAT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 G ST
SACRAMENTO CA
95816-3719
US

IV. Provider business mailing address

2715 G ST
SACRAMENTO CA
95816-3719
US

V. Phone/Fax

Practice location:
  • Phone: 916-447-1502
  • Fax:
Mailing address:
  • Phone: 916-447-1502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: