Provider Demographics
NPI:1023885654
Name:MANGIN, SABRINA ROSE
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:ROSE
Last Name:MANGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:ROSE
Other - Last Name:BAVARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8197 BUFFHAM RD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-9638
Mailing Address - Country:US
Mailing Address - Phone:724-993-2736
Mailing Address - Fax:
Practice Address - Street 1:8197 BUFFHAM RD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-9638
Practice Address - Country:US
Practice Address - Phone:724-993-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
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