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General NPI Number Information
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NPI Number | 1407143514
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Entity Type | Individual
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Provider Name | JEAN-PAUL CERCEAUX MANGUDO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 08/12/2017
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Provider Practice Location Address
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Address Line | 4300 ALTON RD
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City | MIAMI BEACH
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State | FL
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Zip | 33140-2948
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Country | US
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Telephone | 305-250-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 WASHINGTON COURT APARTMENT 307
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City | MIAMI BEACH
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State | FL
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Zip | 33139
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Country | US
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Telephone | 314-580-0461
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME123999
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License Number State | FL
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