Healthcare Provider Details

I. General information

NPI: 1063415230
Provider Name (Legal Business Name): DR. ANGELA MANANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANATI MEDICAL CENTER DR. OTERO LOPEZ SUITE 105 URB. ATENAS CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 858
MANATI PR
00674-0858
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-6066
  • Fax: 787-884-7217
Mailing address:
  • Phone: 787-854-6066
  • Fax: 787-884-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number4168
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1324
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPREFERRED MEDICARE CHOICE
# 2
Identifier25607
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE-SSS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: