Individual
NICHOLAS MANGUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E 2ND ST STE 300, RENO, NV 89502-1198
(775) 982-5000
(775) 982-3900
Mailing address
1500 E 2ND ST STE 300, RENO, NV 89502-1198
(775) 982-5000
(775) 982-3900
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
137149
CA
208600000X
Surgery Physician
Primary
22231
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13863245
CAQH #
NV
01
—
22231
NV LIC#
NV
Enumeration date
07/16/2015
Last updated
08/02/2022
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