MEDICARE: SAISHO MANGLA D.O.

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	208000000X	Pediatrics Physician	008045	AZ

General Provider Information

NPI Number	:	1235543919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAISHO MANGLA D.O.

Provider Business Mailing Address
First Line	:	1435 S ALMA SCHOOL RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-7144
Country	:	US
Telephone Number	:	480-668-1600
Fax Number	:	480-668-1615

Provider Business Practice Location Address
First Line	:	1435 S ALMA SCHOOL RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-7144
Country	:	US
Telephone Number	:	480-668-1600
Fax Number	:	480-668-1615

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

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	03/27/2024

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