Basic Information
| Provider Information | |||||||||
| NPI: | 1629051537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANGROLA | ||||||||
| FirstName: | UMENGSINH | ||||||||
| MiddleName: | GAMELSINH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3768 | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953443768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097233704 | ||||||||
| FaxNumber: | 2097230272 | ||||||||
| Practice Location | |||||||||
| Address1: | 374 W OLIVE AVE STE A | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953483181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093845766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA16980 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1059963 | 01 | CA | NCCPA CERT # | OTHER | MM1042819 | 01 | CA | DEA CERT | OTHER |