Provider Demographics
NPI:1699851303
Name:CAROL ANNE WALKER & JOHN J MANGONI MDS
Entity type:Organization
Organization Name:CAROL ANNE WALKER & JOHN J MANGONI MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAVEHARD
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:626-795-0617
Mailing Address - Street 1:675 S ARROYO PKWY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-795-0617
Mailing Address - Fax:
Practice Address - Street 1:675 S ARROYO PKWY
Practice Address - Street 2:SUITE 420
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-795-0617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty