Provider Demographics
NPI:1245615004
Name:MORALES MANGUAL, ANABEL MARIA (MD)
Entity type:Individual
Prefix:
First Name:ANABEL
Middle Name:MARIA
Last Name:MORALES MANGUAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 S FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2101
Mailing Address - Country:US
Mailing Address - Phone:863-209-7004
Mailing Address - Fax:863-274-3542
Practice Address - Street 1:4715 S FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2101
Practice Address - Country:US
Practice Address - Phone:863-209-7004
Practice Address - Fax:863-274-3542
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME147414207Q00000X
PR19139208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice