Provider Demographics
NPI:1205840451
Name:MANGAR, STEVEN KEITH (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:KEITH
Last Name:MANGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 E ROMIE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4206
Mailing Address - Country:US
Mailing Address - Phone:831-751-3334
Mailing Address - Fax:831-751-3339
Practice Address - Street 1:680 E ROMIE LN
Practice Address - Street 2:SUITE B
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4206
Practice Address - Country:US
Practice Address - Phone:831-751-3334
Practice Address - Fax:831-751-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A654761Medicare ID - Type Unspecified
CAH47735Medicare UPIN