Individual
CHEYENNE MACKENZIE MANGOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 743-0019
Mailing address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-4000
(210) 358-4775
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
T5620
TX
2080P0203X
Pediatric Critical Care Medicine Physician
T5620
TX
Other
Enumeration date
04/18/2019
Last updated
04/09/2026
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