Provider Demographics
NPI:1497120059
Name:MANGUAL, DAVID OMAR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:OMAR
Last Name:MANGUAL
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 1:6787 W TROPICANA AVE STE 120B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4762
Mailing Address - Country:US
Mailing Address - Phone:702-659-8827
Mailing Address - Fax:
Practice Address - Street 1:6787 W TROPICANA AVE STE 120B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4762
Practice Address - Country:US
Practice Address - Phone:702-659-8827
Practice Address - Fax:702-852-0984
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)