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Organization

CORAL VITALITY LLC

Active
Other names
Coral Vitality LLC
Organization subpart
No

Provider details

NPI number
Authorized official
STEPHANIE MANGUAL (PMHNP)
(915) 221-5595
Entity
Organization

Contact information

Practice address
121 WYATT DR STE 18, LAS CRUCES, NM 88005-2961
(575) 570-3671
(575) 232-0631
Mailing address
6204 BRAZOS RIVER ST, EL PASO, TX 79932-1222

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary

Other

Enumeration date
09/05/2023
Last updated
09/05/2023
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