MEDICARE: MANGALA GOPAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	2022-02279	NC
2	2084N0400X	Neurology Physician	0102207418	VA
3	2084N0400X	Neurology Physician	009820	AZ
4	2084N0400X	Neurology Physician	93357	GA
5	2084N0400X	Neurology Physician	18662	CA

General Provider Information

NPI Number	:	1043742703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANGALA GOPAL

Provider Business Mailing Address
First Line	:	7402 HOLLISTER AVE
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-2583
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7402 HOLLISTER AVE
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93117-2583
Country	:	US
Telephone Number	:	805-532-8686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2017
Last Update Date	:	09/19/2022

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Directions to “ MANGALA GOPAL ” Practice Location

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