Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A120558 | CA |
NPI | 1003047978 |
---|---|
Provider Name | Dr. Edwin Marcelo Mangune |
First Address | Bellflower, CA 90706-8041 |
Second Address | Bellflower, CA 90706-8041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 23/09/2021 |