Organization
ANGELS OF ARK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANGA TELIDEVARA NP (OWNER)
(281) 650-0945
Entity
Organization
Contact information
Practice address
133 PINNER LN APT 4, MEDFORD, OR 97501-7528
(281) 650-0945
(541) 245-7494
Mailing address
133 PINNER LN APT 4, MEDFORD, OR 97501-7528
(281) 650-0945
(541) 245-7494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/22/2025
Last updated
08/22/2025
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