Provider Demographics
NPI:1437347697
Name:MANGALICK, VIP (MD)
Entity Type:Individual
Prefix:DR
First Name:VIP
Middle Name:
Last Name:MANGALICK
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 1:2406 HUNTER RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5256
Mailing Address - Country:US
Mailing Address - Phone:512-396-7686
Mailing Address - Fax:512-396-8006
Practice Address - Street 1:2406 HUNTER RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666
Practice Address - Country:US
Practice Address - Phone:512-396-7686
Practice Address - Fax:512-396-8006
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine