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Organization
MANGROVE MEDICAL GROUP
Active
Organization
MANGROVE MEDICAL GROUP
Active
Other names
Mangrove Lab & XRay
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH A MULLINS (ADMINISTRATOR)
(530) 345-0064
Entity
Organization
Contact information
Practice address
1040 MANGROVE AVE, CHICO, CA 95926-3509
(530) 345-0064
(530) 345-0680
Mailing address
1040 MANGROVE AVE, CHICO, CA 95926-3509
(530) 345-0064
(530) 345-0680
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
CA
207VG0400X
Gynecology Physician
—
—
208D00000X
General Practice Physician
—
CA
261QR0206X
Mammography Clinic/Center
RHC 110619
CA
291U00000X
Clinical Medical Laboratory
05DO644223
CA
363L00000X
Nurse Practitioner
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470000743
RAILROAD MEDICARE
CA
Enumeration date
10/21/2005
Last updated
01/04/2022
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