Provider Demographics
NPI:1417246596
Name:CHUCK MANGUBAT, P.C.
Entity Type:Organization
Organization Name:CHUCK MANGUBAT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANGUBAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-460-0746
Mailing Address - Street 1:706 E BELL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-6642
Mailing Address - Country:US
Mailing Address - Phone:480-460-0746
Mailing Address - Fax:480-460-4373
Practice Address - Street 1:706 E BELL RD STE 207
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6642
Practice Address - Country:US
Practice Address - Phone:480-460-0746
Practice Address - Fax:480-460-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty