Provider Demographics
NPI:1144934043
Name:MONGALA, CASSANDRA (DOULA)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:
Last Name:MONGALA
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19195 FREELAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1902
Mailing Address - Country:US
Mailing Address - Phone:313-719-8199
Mailing Address - Fax:
Practice Address - Street 1:19195 FREELAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1902
Practice Address - Country:US
Practice Address - Phone:313-719-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula