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General NPI Number Information
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NPI Number | 1194204321
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Entity Type | Individual
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Provider Name | ANTONIO AUGUSTO MANRIQUE MD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 500 N HIATUS RD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5213
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Country | US
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Telephone | 305-610-5328
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 NE 98TH ST
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City | MIAMI SHORES
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State | FL
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Zip | 33138-2508
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Country | US
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Telephone | 786-624-9481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 135542
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License Number State | FL
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