Provider Demographics
NPI:1356743017
Name:CONCEPCION R MANGASEP M.D, INC.
Entity type:Organization
Organization Name:CONCEPCION R MANGASEP M.D, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONCEPCION
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:MANGASEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-818-6032
Mailing Address - Street 1:7661 PUERTO RICO DRIVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1270
Mailing Address - Country:US
Mailing Address - Phone:702-818-6032
Mailing Address - Fax:714-363-5539
Practice Address - Street 1:7661 PUERTO RICO DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1270
Practice Address - Country:US
Practice Address - Phone:702-818-6032
Practice Address - Fax:714-363-5539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66574273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit