Provider Demographics
NPI:1932668720
Name:MANGINO, REYNA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:REYNA
Middle Name:MICHELLE
Last Name:MANGINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:REYNA
Other - Middle Name:MICHELLE
Other - Last Name:LUPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:
Practice Address - Street 1:6939 SUNRISE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-3153
Practice Address - Country:US
Practice Address - Phone:916-547-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator