=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295031920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAJU MANGROLA, MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2011
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 MILITARY TRAIL SUITE 206
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-691-1400
-----------------------------------------------------
Fax | 561-691-1423
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4600 MILITARY TRAIL SUITE 206
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-4812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-691-1400
-----------------------------------------------------
Fax | 561-691-1423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. RAJU MANGROLA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-691-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------