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General NPI Number Information
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NPI Number | 1336122084
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Entity Type | Individual
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Provider Name | RICARDO ANTONIO MANGIONE PA
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Gender | Male
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 6200 SUNSET DR SUITE 403
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4828
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Country | US
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Telephone | 305-740-8036
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Fax | 305-740-8137
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Provider Business Mailing Address
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Address Line | 10314 SW 128TH CT
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City | MIAMI
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State | FL
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Zip | 33186-2321
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Country | US
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Telephone | 786-413-4051
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102135
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9102135
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License Number State | FL
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