Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4168 | PR |
NPI | 1063415230 |
---|---|
Provider Name | Dr. Angela Manana |
First Address | Manati, PR 00674-0858 |
Second Address | Manati, PR 00674 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 09/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1324 | PREFERRED MEDICARE CHOICE (01) | PR |
25607 | TRIPLE-SSS (01) | PR |
E-31147 | (02) | PR |