Provider Demographics
NPI:1003877879
Name:MANNARINO, MARIO JOHN (IDC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JOHN
Last Name:MANNARINO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSFSC SHIP SUPPORT UNIT, GUAM
Mailing Address - Street 2:PSC 455, BOX 198
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96540-2600
Mailing Address - Country:US
Mailing Address - Phone:671-339-2284
Mailing Address - Fax:671-339-2208
Practice Address - Street 1:MSFSC SHIP SUPPORT UNIT, GUAM
Practice Address - Street 2:PSC 455, BOX 198
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96540-2600
Practice Address - Country:US
Practice Address - Phone:671-339-2284
Practice Address - Fax:671-339-2208
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman