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NPI Code Detail

MEDICARE: BERNARD ALBERT MANGONE D.V.M.

MEDICARE: BERNARD ALBERT MANGONE D.V.M.
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
1174M00000XVeterinarian3371AZ

General Provider Information

NPI Number : 1245670363
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNARD ALBERT MANGONE D.V.M.
Provider Business Mailing Address
First Line : 16021 N 7TH DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85023-4437
Country : US
Telephone Number : 602-695-5477
Fax Number :
Provider Business Practice Location Address
First Line : 7771 N 43RD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-5712
Country : US
Telephone Number : 602-841-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2013
Last Update Date : 07/03/2013

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