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NPI Code Detail

MEDICARE: MONA LISA MANUEL

MEDICARE:   MONA LISA MANUEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1699077388
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONA LISA MANUEL
Provider Business Mailing Address
First Line : 5055 W HACIENDA AVE
Second Line : 1135
City : LAS VEGAS
State : NV
Zip : 89118-0323
Country : US
Telephone Number : 702-442-0483
Fax Number :
Provider Business Practice Location Address
First Line : 5055 W HACIENDA AVE
Second Line : 1135
City : LAS VEGAS
State : NV
Zip : 89118-0323
Country : US
Telephone Number : 702-442-0483
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2010
Last Update Date : 12/01/2010

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Directions to “ MONA LISA MANUEL ” Practice Location

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