Healthcare Provider Details

I. General information

NPI: 1982649539
Provider Name (Legal Business Name): ANTONIO DECLET MANZANET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2337
US

IV. Provider business mailing address

20 CALLE RIUS RIVERA
ADJUNTAS PR
00601-2337
US

V. Phone/Fax

Practice location:
  • Phone: 787-829-4476
  • Fax: 787-829-2569
Mailing address:
  • Phone: 787-829-4476
  • Fax: 787-829-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number5393
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5393
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: