Provider Demographics
NPI:1609511633
Name:MANGAOANG, CZARINA DIANNE VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:CZARINA DIANNE
Middle Name:VICTOR
Last Name:MANGAOANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8946 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-1251
Mailing Address - Country:US
Mailing Address - Phone:818-661-7666
Mailing Address - Fax:
Practice Address - Street 1:8946 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91775-1251
Practice Address - Country:US
Practice Address - Phone:818-661-7666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program