Provider Demographics
NPI:1265782148
Name:MANGUAL, XIOMARA
Entity type:Individual
Prefix:MS
First Name:XIOMARA
Middle Name:
Last Name:MANGUAL
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 1:200 VALENTINE LN APT 5M
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-3607
Mailing Address - Country:US
Mailing Address - Phone:914-564-3205
Mailing Address - Fax:
Practice Address - Street 1:200 VALENTINE LN APT 5M
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3607
Practice Address - Country:US
Practice Address - Phone:914-564-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist