Provider Demographics
NPI:1639281835
Name:RIPDEEP MANGAT MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RIPDEEP MANGAT MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIPDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-683-4171
Mailing Address - Street 1:26895 ALISO CREEK RD
Mailing Address - Street 2:SUITE B581
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 360
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-683-4171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65357207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19631Medicare ID - Type UnspecifiedGROUP MEDICARE ID
CAWA65357CMedicare ID - Type UnspecifiedPPIN