MEDICARE: DR. MARK RYAN MANGIAPANE 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	207Q00000X	Family Medicine Physician	20A16246	CA

General Provider Information

NPI Number	:	1922394782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RYAN MANGIAPANE D.O.

Provider Business Mailing Address
First Line	:	2200 COLORADO AVE
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-2004
Country	:	US
Telephone Number	:	209-250-2683
Fax Number	:	209-250-2684

Provider Business Practice Location Address
First Line	:	2200 COLORADO AVE
Second Line	:
City	:	TURLOCK
State	:	CA
Zip	:	95382-2004
Country	:	US
Telephone Number	:	209-250-2683
Fax Number	:	209-250-2684

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	11/13/2020

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Directions to “ DR. MARK RYAN MANGIAPANE D.O.” Practice Location

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