Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1720395940 |
---|---|
Provider Name | Mr. Reginald Jay Mangone |
First Address | Long Beach, CA 90804-4269 |
Second Address | Long Beach, CA 90804-4269 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 09/09/2010 |