MEDICARE: MANA THERAPEUTICS LLC

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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1780428698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANA THERAPEUTICS LLC

Provider Business Mailing Address
First Line	:	1728 HOWARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1728 HOWARD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3631
Country	:	US
Telephone Number	:	702-884-3414
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN MEJIA
Credential	:
Telephone Number	:	702-884-1696

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	06/24/2024

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