Provider Demographics
NPI:1871083329
Name:MANGUINO, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:MANGUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11745 STONEWALL SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1577
Mailing Address - Country:US
Mailing Address - Phone:702-445-0088
Mailing Address - Fax:
Practice Address - Street 1:2757 GALLANT HILLS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1757
Practice Address - Country:US
Practice Address - Phone:702-445-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)