Healthcare Provider Details

I. General information

NPI: 1487129367
Provider Name (Legal Business Name): VICENTE JOSE COGOLLO MANGONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

V. Phone/Fax

Practice location:
  • Phone: 319-678-8160
  • Fax: 319-353-6511
Mailing address:
  • Phone: 319-678-8160
  • Fax: 319-353-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME163948
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD-56473
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: