Provider Demographics
NPI:1013174929
Name:MANGO, HOWARD T
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:T
Last Name:MANGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OLD NEWPORT BOULEVARD
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663
Mailing Address - Country:US
Mailing Address - Phone:949-642-7935
Mailing Address - Fax:949-642-2950
Practice Address - Street 1:500 OLD NEWPORT BLVD
Practice Address - Street 2:STE 101
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4234
Practice Address - Country:US
Practice Address - Phone:949-642-7935
Practice Address - Fax:949-642-2950
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAUD379231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAUD379Medicare UPIN