Provider Demographics
NPI:1265277529
Name:MONGARE, REUBEN
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:
Last Name:MONGARE
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 1:21311 WALDENBURG PL
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1934
Mailing Address - Country:US
Mailing Address - Phone:848-239-8209
Mailing Address - Fax:
Practice Address - Street 1:21311 WALDENBURG PL
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1934
Practice Address - Country:US
Practice Address - Phone:713-498-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95383135163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse