Individual
MATILDA MANKA MANGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
42756 PORTRAITS LN, TEMECULA, CA 92592
(949) 351-3238
Mailing address
42756 PORTRAITS LN, TEMECULA, CA 92592
(949) 351-3238
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP95006288
CA
364SG0600X
Gerontology Clinical Nurse Specialist
NP95006288
CA
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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