Provider Demographics
NPI:1043332109
Name:MANGIAPANE, LAWRENCE D III
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:D
Last Name:MANGIAPANE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15770 MOJAVE DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1934
Mailing Address - Country:US
Mailing Address - Phone:760-843-7809
Mailing Address - Fax:760-843-7810
Practice Address - Street 1:15770 MOJAVE DR
Practice Address - Street 2:SUITE L
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1934
Practice Address - Country:US
Practice Address - Phone:760-843-7809
Practice Address - Fax:760-843-7810
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)