Jose G Mangrobang Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1565 Issued in NV

Practice address

4700 Las Vegas Blvd N
Nellis Afb, NV 89191-6600

Phone

(702) 653-2764

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1508946294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-2764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGROBANG",
        "first_name": "JOSE",
        "middle_name": "G",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Paul Macayan
• Karen Leigh Main, RN
• Taylor Gregory Majerus, PT, DPT, OCS, SCS
• Peter J Malamet, DO
• Laura Malchodi, MD
• Lisa Marie Mannina, M.D.
• Sarah Ashley Manning, MD
• Clark Mantooth
• Jacen S Mapes, PA-C
• Mira Kate Marchioretto

• Physician Assistant in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• Physician Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.