Healthcare Provider Details

I. General information

NPI: 1144729344
Provider Name (Legal Business Name): RANDA MOUGARBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LIBBY ST
BROCKTON MA
02302-2949
US

IV. Provider business mailing address

25 LIBBY ST
BROCKTON MA
02302-2949
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-0400
  • Fax: 508-894-0772
Mailing address:
  • Phone: 508-894-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309093
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2272611
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License NumberRN2272611
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: