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General NPI Number Information
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NPI Number | 1245794700
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Entity Type | Individual
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Provider Name | MARTIN RAUL GARCIA MANZANILLO II MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 210 PASEO TRIO VEGABAJENO APT 226
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City | VEGA BAJA
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State | PR
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Zip | 00693-5844
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Country | US
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Telephone | 939-251-3233
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Fax |
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Provider Business Mailing Address
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Address Line | 210 PASEO TRIO VEGABAJENO APT 226
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City | VEGA BAJA
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State | PR
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Zip | 00693-5844
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Country | US
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Telephone | 939-251-3233
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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