Provider Demographics
NPI:1437838679
Name:MANGALINO, MARV ALWYN
Entity Type:Individual
Prefix:
First Name:MARV ALWYN
Middle Name:
Last Name:MANGALINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3801
Mailing Address - Country:US
Mailing Address - Phone:702-690-6156
Mailing Address - Fax:
Practice Address - Street 1:11920 SOUTHERN HIGHLANDS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3273
Practice Address - Country:US
Practice Address - Phone:702-435-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant