Provider Demographics
NPI:1174364061
Name:MBANGO ENTERPRISES LLC
Entity type:Organization
Organization Name:MBANGO ENTERPRISES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BENEDICTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MBANGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-717-9288
Mailing Address - Street 1:1450 S HAVANA ST STE 522
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4030
Mailing Address - Country:US
Mailing Address - Phone:720-496-3160
Mailing Address - Fax:720-370-2994
Practice Address - Street 1:1450 S HAVANA ST STE 522
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4030
Practice Address - Country:US
Practice Address - Phone:720-496-3160
Practice Address - Fax:720-370-2994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MBANGO ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty