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General NPI Number Information
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NPI Number | 1790878783
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Entity Type | Individual
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Provider Name | ANJI R MANTHENA MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD
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City | WEBSTER
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State | TX
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Zip | 77598-4220
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Country | US
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Telephone | 281-332-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 RAY SHELL CT
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City | SEABROOK
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State | TX
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Zip | 77586-4585
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Country | US
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Telephone | 281-291-8226
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | F0631
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License Number State | TX
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