Provider Demographics
NPI:1134155021
Name:MANGINI, ANNA (NP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MANGINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:818-295-3395
Practice Address - Street 1:23388 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2733
Practice Address - Country:US
Practice Address - Phone:818-876-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1542363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS71038Medicare UPIN
CAWNP1542CMedicare ID - Type UnspecifiedPPIN
CAWNP1542GMedicare ID - Type UnspecifiedPPIN
CAWNP1542EMedicare ID - Type UnspecifiedPPIN
CAWNP1542DMedicare ID - Type UnspecifiedPPIN
CAWNP1542FMedicare ID - Type UnspecifiedPPIN