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NPI Code Detail

MEDICARE: RUTH ROBERTA MANGINO N.P.

MEDICARE: RUTH ROBERTA MANGINO N.P.
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
1363LA2200XAdult Health Nurse PractitionerRN087831AZ
2363LA2200XAdult Health Nurse PractitionerAP3232AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2Z204343OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194961664
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUTH ROBERTA MANGINO N.P.
Provider Business Mailing Address
First Line : 3815 E BELL RD STE 2200
Second Line :
City : PHOENIX
State : AZ
Zip : 85032-2139
Country : US
Telephone Number : 602-633-3838
Fax Number : 602-633-3845
Provider Business Practice Location Address
First Line : 7330 N 99TH AVE STE 325
Second Line :
City : GLENDALE
State : AZ
Zip : 85307-3022
Country : US
Telephone Number : 623-209-1474
Fax Number : 623-209-1475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2009
Last Update Date : 06/28/2019

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Directions to “ RUTH ROBERTA MANGINO N.P.” Practice Location

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