Provider Demographics
NPI:1306395587
Name:ALIGNED COMMUNITY PHYSICIANS
Entity Type:Organization
Organization Name:ALIGNED COMMUNITY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-687-0004
Mailing Address - Street 1:9041 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 008
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3900
Mailing Address - Country:US
Mailing Address - Phone:951-687-0004
Mailing Address - Fax:
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:SUITE 008
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-687-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3942935208D00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty