Individual
VICTOR SUVA-VIOLA MANGONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 W ROYAL LN, IRVING, TX 75063-3213
(469) 513-5500
(469) 420-9600
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-2987
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301094323
MI
2085R0001X
Radiation Oncology Physician
Primary
Q5028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201312910A
—
KS
05
—
240726001
—
AR
05
—
348568201
—
TX
05
—
348568202
—
TX
05
—
348568203
—
TX
01
—
P01667436
RAILROAD
TX
Enumeration date
05/26/2009
Last updated
02/03/2021
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