Provider Demographics
NPI:1194961664
Name:MANGINO, RUTH ROBERTA (NP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ROBERTA
Last Name:MANGINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 2200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2139
Mailing Address - Country:US
Mailing Address - Phone:602-633-3838
Mailing Address - Fax:602-633-3845
Practice Address - Street 1:7330 N 99TH AVE STE 325
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85307-3022
Practice Address - Country:US
Practice Address - Phone:623-209-1474
Practice Address - Fax:623-209-1475
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN087831363LA2200X
AZAP3232363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ403458Medicaid
Z204343OtherMEDICARE