Provider Demographics
NPI:1326327511
Name:MWANGALE, FIONA L (NP)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:L
Last Name:MWANGALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6657
Mailing Address - Country:US
Mailing Address - Phone:323-442-5910
Mailing Address - Fax:323-442-6888
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-5910
Practice Address - Fax:323-442-6888
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFN083ZMedicare PIN