Provider Demographics
NPI:1669067237
Name:MANGAOANG, ROEL CRISOSTOMO
Entity type:Individual
Prefix:
First Name:ROEL
Middle Name:CRISOSTOMO
Last Name:MANGAOANG
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 1:239 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-4729
Mailing Address - Country:US
Mailing Address - Phone:754-152-4310
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSE BLVD
Practice Address - Street 2:
Practice Address - City:JUNO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-2444
Practice Address - Country:US
Practice Address - Phone:561-627-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7009208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation