MEDICARE: ANNA MANGINI NP

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	363L00000X	Nurse Practitioner	1542	CA

General Provider Information

NPI Number	:	1134155021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA MANGINI NP

Provider Business Mailing Address
First Line	:	4323 W RIVERSIDE DR
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4044
Country	:	US
Telephone Number	:
Fax Number	:	818-295-3395

Provider Business Practice Location Address
First Line	:	23388 MULHOLLAND DR
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2733
Country	:	US
Telephone Number	:	818-876-1888
Fax Number	:

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	12/23/2010

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