Provider Demographics
NPI:1760208268
Name:MANGAHAS, WENDIE DO
Entity type:Individual
Prefix:
First Name:WENDIE
Middle Name:DO
Last Name:MANGAHAS
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 1:2951 W LINCOLN AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-8251
Mailing Address - Country:US
Mailing Address - Phone:714-391-3081
Mailing Address - Fax:
Practice Address - Street 1:11402 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6611
Practice Address - Country:US
Practice Address - Phone:855-635-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily