Individual
IRENE MANGACU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2370 CARSON ST, REDWOOD CITY, CA 94061-2008
(805) 302-6412
Mailing address
4261 STEVENSON BLVD, APT. 286, FREMONT, CA 94538-2787
(805) 302-6412
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
697151
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95000476
CA
Other
Enumeration date
12/04/2015
Last updated
06/17/2022
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