MEDICARE: JACKSON MAINA NGANGA 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
1	208000000X	Pediatrics Physician	ME132336	FL
2	208000000X	Pediatrics Physician	D0053131	MD
3	208000000X	Pediatrics Physician	21137	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962406835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON MAINA NGANGA M.D.

Provider Business Mailing Address
First Line	:	1210 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 S OLD DIXIE HWY
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7205
Country	:	US
Telephone Number	:	561-263-2234
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/03/2021

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Directions to “ JACKSON MAINA NGANGA M.D.” Practice Location

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