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General NPI Number Information
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NPI Number | 1548029580
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Entity Type | Organization
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Legal Business Name | MANGO MEDICAL DPC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 23 S MALLORY ST STE C
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City | HAMPTON
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State | VA
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Zip | 23663-1707
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Country | US
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Telephone | 757-210-5959
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Fax | 800-313-5613
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Provider Business Mailing Address
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Address Line | 23 S MALLORY ST STE B
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City | HAMPTON
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State | VA
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Zip | 23663-1707
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Country | US
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Telephone | 757-210-5959
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Fax | 800-313-5613
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Authorized Official
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Title or Position | MD/CEO
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Name | NZINGA TEULE-HEKIMA
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Credential | MD
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Telephone | 757-210-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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