Luther Mangoba, Md Inc.

LBN: Luther Mangoba, Md Inc.
Luther Mangoba, Md Inc. is an health care organization with primary practice located at 9041 Magnolia Ave Suite 008, Riverside CA 92503-3900. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Luther Mangoba, Md Inc. can be contacted via phone (951) 687-0004, or through Mangoba, Luther via phone (951) 687-0004.

Contact Information

Primary practice address
9041 Magnolia Ave Suite 008 Riverside CA 92503-3900
Phone: (951) 687-0004
Fax: (951) 687-0080
Website:
Map and Directions
Authorized official contact:
Name: Mangoba, Luther Doctor of Medicine (MD)
Phone: (951) 687-0004

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 05D1038270 California

Profile Details

NPI number 1558387209
LBN Legal business name Luther Mangoba, Md Inc.
DBA Doing business as
Authorized official Mangoba, Luther Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jul 14th, 2006
Last updated Jul 3rd, 2014 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558387209 NPPES
California Other 05D1038270 CLIA WAIVER CERTIFICATE
California MEDICAID 00A775740 CLIA WAIVER CERTIFICATE

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