Healthcare Provider Details

I. General information

NPI: 1306147160
Provider Name (Legal Business Name): MANTA MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 CALLE GLASGOW
SAN JUAN PR
00921-4820
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 486
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-294-5551
  • Fax:
Mailing address:
  • Phone: 787-294-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. DIEGO JOSE LOINAZ
Title or Position: PRESIDENT
Credential:
Phone: 787-294-5551