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NPI Code Detail

MEDICARE: KATE LOUISE MORENG MANGONA M.D.

MEDICARE: KATE LOUISE MORENG MANGONA 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
12085R0202XDiagnostic Radiology PhysicianQ4192TX
22085P0229XPediatric Radiology PhysicianQ4192TX

General Provider Information

NPI Number : 1780815753
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATE LOUISE MORENG MANGONA M.D.
Provider Business Mailing Address
First Line : PO BOX 845347
Second Line :
City : DALLAS
State : TX
Zip : 75284-5347
Country : US
Telephone Number : 214-648-7759
Fax Number :
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number : 214-648-7759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2009
Last Update Date : 03/10/2026

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