Provider Demographics
NPI:1245670363
Name:MANGONE, BERNARD ALBERT (DVM)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:ALBERT
Last Name:MANGONE
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16021 N 7TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4437
Mailing Address - Country:US
Mailing Address - Phone:602-695-5477
Mailing Address - Fax:
Practice Address - Street 1:7771 N 43RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5712
Practice Address - Country:US
Practice Address - Phone:602-841-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3371174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian