Individual
DR. JUSSEIN RIGOR MANGONDATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
701 E CHANNEL ST, STOCKTON, CA 95202-2628
(209) 944-4700
Mailing address
PO BOX 779, STOCKTON, CA 95201-0779
(209) 373-2800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A82555
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0071200
—
CA
Enumeration date
08/31/2006
Last updated
01/30/2012
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