Provider Demographics
NPI:1447498019
Name:MANGWIRO AND ASSOCIATES PLLC
Entity type:Organization
Organization Name:MANGWIRO AND ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANGWIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-206-8904
Mailing Address - Street 1:4321 N BELT LINE RD
Mailing Address - Street 2:STE 500
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3133
Mailing Address - Country:US
Mailing Address - Phone:214-206-8904
Mailing Address - Fax:214-206-8502
Practice Address - Street 1:4321 N BELT LINE RD
Practice Address - Street 2:STE 500
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3133
Practice Address - Country:US
Practice Address - Phone:214-206-8904
Practice Address - Fax:214-206-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX051977251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health