Individual
JUSTIN SCOTT MANGUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
940 AVENUE 64, PASADENA, CA 91105-2711
(323) 254-2274
Mailing address
940 AVENUE 64, PASADENA, CA 91105-2711
(323) 254-2274
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
03/16/2007
Last updated
07/08/2007
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