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General NPI Number Information
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NPI Number | 1174364061
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Entity Type | Organization
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Legal Business Name | MBANGO ENTERPRISES LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1450 S HAVANA ST STE 522
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City | AURORA
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State | CO
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Zip | 80012-4030
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Country | US
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Telephone | 720-496-3160
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Fax | 720-370-2994
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Provider Business Mailing Address
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Address Line | 1450 S HAVANA ST STE 522
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City | AURORA
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State | CO
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Zip | 80012-4030
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Country | US
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Telephone | 720-496-3160
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Fax | 720-370-2994
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Authorized Official
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Title or Position | OWNER/ AUTHORIZED OFFICIAL
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Name | BENEDICTO MBANGO
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Credential |
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Telephone | 720-717-9288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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