MEDICARE: VICENTE JOSE COGOLLO MANGONES MD

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	208200000X	Plastic Surgery Physician	MD-56473	IA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208600000X	Surgery Physician	ME163948	FL

General Provider Information

NPI Number	:	1487129367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICENTE JOSE COGOLLO MANGONES MD

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:	319-678-8160
Fax Number	:	319-353-6511

Provider Business Practice Location Address
First Line	:	11750 BIRD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-3530
Country	:	US
Telephone Number	:	305-223-2000
Fax Number	:	305-227-5556

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

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	01/27/2026

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