Individual
SOE TIN MAUNGLAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 BROCKTON AVE STE 316, RIVERSIDE, CA 92501-4090
(951) 394-3055
(951) 394-3077
Mailing address
51753 EL DORADO DR, LA QUINTA, CA 92253-9034
(760) 619-2309
(866) 428-0708
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
C152411
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093-896
BLUE CROSS BLUE SHEILD
MI
01
—
124237
AL MEDICAID- NORTH DAVIS
AL
01
—
124241
AL MEDICAID- GULF BREEZE
AL
01
—
124493
AL MEDICAID- BREWTON
AL
05
—
277913700
—
FL
01
—
P17390012
MEDICARE
MI
Enumeration date
01/09/2007
Last updated
09/08/2020
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