=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033519657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE LINE COMMUNITY HEALTHCARE CALIFORNIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2014
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25350 MAGIC MOUNTAIN PKWY STE 300
-----------------------------------------------------
City | VALENCIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91355-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-388-3781
-----------------------------------------------------
Fax | 866-345-6156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6111 OAK TREE BLVD STE 301
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44131-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-388-3781
-----------------------------------------------------
Fax | 866-345-6156
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANDREW J MANGANARO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 888-388-3781
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 33259
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------