Provider Demographics
NPI:1851899876
Name:MANGANO, DENNIS THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:THOMAS
Last Name:MANGANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GENEVRA RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6423
Mailing Address - Country:US
Mailing Address - Phone:650-814-3203
Mailing Address - Fax:
Practice Address - Street 1:30 GENEVRA RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:CA
Practice Address - Zip Code:94010-6423
Practice Address - Country:US
Practice Address - Phone:650-814-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30799207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG30799OtherCALIFORNIA LICENSE