Matilda Manka Mangan, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

NP95006288 Issued in CA

Practice address

42756 Portraits LN
Temecula, CA 92592

Phone

(949) 351-3238

NPI assigned

Apr 3, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Coast Health and Rehab PCGroup PAC ID 8325315609, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Coast Health and Rehab PC

  • Physical Medicine & Rehabilitation Physician
  • Edgewater, NJ
  • NPI 1043743891

  CA

  Medicare reassignment Care Compare group
• Altea Medical California PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Eureka, CA
  • NPI 1174302954
  Medicare reassignment NPD
• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1598703647
  Medicare reassignment NPD
• Integrated Rehab Consultants California Inc

  • Physical Medicine & Rehabilitation Physician
  • Playa del Rey, CA
  • NPI 1023449741
  Medicare reassignment
• Dr. William J Grimm, Apc

  • Internal Medicine Physician
  • Palm Springs, CA
  • NPI 1285389171
  NPD
• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Beaumont, CA
  • NPI 1629601653
  NPD

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

{
    "created_epoch": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491177600000",
    "number": "1972035442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42756 PORTRAITS LN",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92592",
            "telephone_number": "949-351-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42756 PORTRAITS LN",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92592",
            "telephone_number": "949-351-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGAN",
        "first_name": "MATILDA",
        "middle_name": "MANKA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-03",
        "last_updated": "2017-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "NP95006288",
            "primary": true
        },
        {
            "code": "364SG0600X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Gerontology",
            "state": "CA",
            "license": "NP95006288",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cora Elizabeth Anne Mancaruso
• Yvette Mancilla
• Elyce Darcell Mandich, MSW, LCSW, PPSC
• Mangan Physical Therapy Inc
• Daniel James Mangan, MPT
• Glydelle Mangrobang
• Blake Manhart
• James Mark Manley, M.F.T.
• Summer Manley
• Manmeet Singh Padda MD a Professional Corporation

• Adult Health Nurse Practitioner in Temecula, CA
• Providers in Temecula, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.