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Organization
LUTHER MANGOBA, MD INC.
Active
Organization
LUTHER MANGOBA, MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LUTHER MANGOBA M.D. (PRESIDENT)
(951) 687-0004
Entity
Organization
Contact information
Practice address
9041 MAGNOLIA AVE, SUITE 008, RIVERSIDE, CA 92503-3900
(951) 687-0004
(951) 687-0080
Mailing address
9041 MAGNOLIA AVE, SUITE 008, RIVERSIDE, CA 92503-3900
(951) 687-0004
(951) 687-0080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05D1038270
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A775740
—
CA
01
—
05D1038270
CLIA WAIVER CERTIFICATE
CA
Enumeration date
07/14/2006
Last updated
07/03/2014
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