Healthcare Provider Details

I. General information

NPI: 1962383166
Provider Name (Legal Business Name): BRIAN MANSON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 09/12/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 AVENIDA SAN JORGE
SAN JUAN PR
00912
US

IV. Provider business mailing address

PO BOX 30663
SAN JUAN PR
00929-1663
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number102772
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: