Provider Demographics
NPI:1710914338
Name:MANGLONA, JANNA WILGUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JANNA
Middle Name:WILGUS
Last Name:MANGLONA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANNA
Other - Middle Name:WILGUS
Other - Last Name:CUNDIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:225J ENRIQUE SAN NICOLAS LANE
Mailing Address - Street 2:
Mailing Address - City:TALOFOFO
Mailing Address - State:GU
Mailing Address - Zip Code:96915-3504
Mailing Address - Country:US
Mailing Address - Phone:671-988-5963
Mailing Address - Fax:
Practice Address - Street 1:123 CHALAN KARETA
Practice Address - Street 2:
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-828-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP0268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F08006Medicare UPIN