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General NPI Number Information
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NPI Number | 1831763986
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Entity Type | Individual
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Provider Name | JORDAN MANGAT
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Gender | Female
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 2930 MAPLE ST
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City | EVERETT
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State | WA
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Zip | 98201-3832
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Country | US
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Telephone | 425-261-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 1310 CLUB DR
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City | VALLEJO
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State | CA
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Zip | 94592-1187
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Country | US
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Telephone | 707-638-5809
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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 |
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License Number State |
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