Individual
RAUL ANTONIO MONGUE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19797 NW 226TH TER, HIGH SPRINGS, FL 32643-0664
(352) 215-9460
Mailing address
19797 NW 226TH TER, HIGH SPRINGS, FL 32643-0664
(352) 215-9460
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
M522-720-84-006-0
FL
Other
Enumeration date
04/26/2022
Last updated
04/26/2022
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