Provider Demographics
NPI:1003913534
Name:MANIBO, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:MANIBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1593
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00821-1593
Mailing Address - Country:US
Mailing Address - Phone:340-778-0303
Mailing Address - Fax:
Practice Address - Street 1:ISLAND MEDICAL CENTER
Practice Address - Street 2:8A
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00823
Practice Address - Country:US
Practice Address - Phone:340-778-5819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI149208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIG42978Medicare UPIN