Healthcare Provider Details

I. General information

NPI: 1326675737
Provider Name (Legal Business Name): MAMBO JINGLA NDINGWAN DNP-FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAMBO JINGLA NDINGWAN DNP-FPMHNP

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BEE CAVES RD STE 220
AUSTIN TX
78746-5590
US

IV. Provider business mailing address

3009 SKINNER DR
LORENA TX
76655-3146
US

V. Phone/Fax

Practice location:
  • Phone: 855-204-2502
  • Fax: 817-783-4672
Mailing address:
  • Phone: 209-719-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026542
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP145249
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: