Provider Demographics
NPI:1689784746
Name:POOPALAN, MANGAIRKARASIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MANGAIRKARASIE
Middle Name:
Last Name:POOPALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MANGA
Other - Middle Name:
Other - Last Name:POOPALAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7007
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-7007
Mailing Address - Country:US
Mailing Address - Phone:661-945-5984
Mailing Address - Fax:661-951-3392
Practice Address - Street 1:43839 15TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4756
Practice Address - Country:US
Practice Address - Phone:661-945-5984
Practice Address - Fax:661-951-3392
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417140Medicaid
CAA85686Medicare UPIN
CA00A417140Medicaid