Basic Information
| Provider Information | |||||||||
| NPI: | 1831273770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANGILIT | ||||||||
| FirstName: | LEONARDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10605 BALBOA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188322410 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10605 BALBOA BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GRANADA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913446367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188322410 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN488741 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.