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General NPI Number Information
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NPI Number | 1225327042
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Entity Type | Individual
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Provider Name | REBECCA HEMA MANGALI PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 303 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2709
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Country | US
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Telephone | 386-425-2285
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Fax | 386-425-4577
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Provider Business Mailing Address
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Address Line | 145 CITY PLACE SUITE 101
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City | PALM BEACH
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State | FL
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Zip | 32164
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Country | US
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Telephone | 386-302-0975
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Fax | 386-306-0976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9105157
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License Number State | FL
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