MANGROVE MEDICAL GROUP NPI 1326038381

NPI Information

NPI: 1326038381
Provider Name: MANGROVE MEDICAL GROUP

Other Name: MANGROVE LAB & XRAY

Classification: Family Medicine - 207Q00000X
Entity Type: Organization

Address:
1040 MANGROVE AVE
CHICO, CA
ZIP 95926
Phone: (530) 345-0064
Get Directions

MANGROVE MEDICAL GROUP is a family medicine in Chico, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MANGROVE MEDICAL GROUP NPI is 1326038381. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Mangrove Lab & Xray.

The provider's business location address is:

1040 MANGROVE AVE
CHICO, CA
ZIP 95926-509
Phone: (530) 345-0064
Fax: (530) 345-0680

The provider's authorized official is Elizabeth A Mullins .
The authorized official title is Administrator and has the following contact phone number (530) 345-0064.

The CLIA number assigned to this NPI record is 05D0644223 - physician office with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 10/21/2005 and was last updated on 1/4/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207N00000X	Dermatology				No
2	207ND0900X	Dermatology	Dermatopathology			No
3	207VG0400X	Obstetrics & Gynecology	Gynecology			No
4	208D00000X	General Practice			CALIFORNIA	No
5	261QR0206X	Clinic/Center	Radiology, Mammography	RHC 110619	CALIFORNIA	No
6	291U00000X	Clinical Medical Laboratory		05DO644223	CALIFORNIA	No
7	363L00000X	Nurse Practitioner			CALIFORNIA	No
8	207Q00000X	Family Medicine			CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	470000743	OTHER	CALIFORNIA	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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