Doctor Name: | LAWRENCE D MANGIAPANE |
NPI Number: | 1043332109 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 15770 Mojave Dr Suite L Victorville, CA - 923941934 |
Business Phone Number: | 7608437809 |
Business Fax Number: | 7608437810 |
Mailing Address: | 15770 Mojave Dr, Suite L VICTORVILLE |
State: | CA |
Postal Code: | 923941934 |
Phone Number: | 7608437809 |
Fax Number: | 7608437810 |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |