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NPI Code Detail

MEDICARE: DR. JUSSEIN RIGOR MANGONDATO M.D.

MEDICARE: DR. JUSSEIN RIGOR MANGONDATO M.D.
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
1208000000XPediatrics PhysicianA82555CA

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 : 1306957279
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSSEIN RIGOR MANGONDATO M.D.
Provider Business Mailing Address
First Line : PO BOX 779
Second Line :
City : STOCKTON
State : CA
Zip : 95201-0779
Country : US
Telephone Number : 209-373-2800
Fax Number :
Provider Business Practice Location Address
First Line : 701 E CHANNEL ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-2628
Country : US
Telephone Number : 209-944-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 01/30/2012

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