Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6796 | AZ |
N | 111NI0900X | Internist | 6796 | AZ |
Y | 207RN0300X | Nephrologist | 6796 | AZ |
NPI | 1033165121 |
---|---|
Provider Name | Jan Mangalat |
First Address | Scottsdale, AZ 85255-3416 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218108 | (05) | AZ |
D37231 | (02) |