Individual
DR. ALICIA MANGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16601 N 40TH ST STE 204, PHOENIX, AZ 85032-3356
(602) 633-3721
(602) 595-1127
Mailing address
16601 N 40TH ST STE 204, PHOENIX, AZ 85032-3356
(602) 633-3721
(602) 595-1127
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
45385
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
144729405
—
TX
05
—
665273
—
AZ
Enumeration date
02/07/2006
Last updated
10/21/2021
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