Healthcare Provider Details

I. General information

NPI: 1033519657
Provider Name (Legal Business Name): LIFE LINE COMMUNITY HEALTHCARE CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25350 MAGIC MOUNTAIN PKWY STE 300
VALENCIA CA
91355-1356
US

IV. Provider business mailing address

6111 OAK TREE BLVD STE 301
INDEPENDENCE OH
44131-2585
US

V. Phone/Fax

Practice location:
  • Phone: 888-388-3781
  • Fax: 866-345-6156
Mailing address:
  • Phone: 888-388-3781
  • Fax: 866-345-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number33259
License Number StateCA

VIII. Authorized Official

Name: DR. ANDREW J MANGANARO
Title or Position: OWNER
Credential: M.D.
Phone: 888-388-3781