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General NPI Number Information
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NPI Number | 1558489203
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Entity Type | Individual
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Provider Name | MAVIS MANTHE
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 195 PLACERVILLE RD STE 120
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City | FOLSOM
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State | CA
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Zip | 95630-6319
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Country | US
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Telephone | 916-235-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 BRICKELL AVE STE N1700
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City | MIAMI
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State | FL
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Zip | 33131-3105
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Country | US
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Telephone | 916-983-2942
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Fax | 916-983-6054
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA2179
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License Number State | CA
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