Provider Demographics
NPI:1194463067
Name:MANANGAN, RIZA (NP)
Entity Type:Individual
Prefix:
First Name:RIZA
Middle Name:
Last Name:MANANGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3825
Mailing Address - Country:US
Mailing Address - Phone:443-559-2892
Mailing Address - Fax:
Practice Address - Street 1:815 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3535
Practice Address - Country:US
Practice Address - Phone:410-642-9172
Practice Address - Fax:877-635-7186
Is Sole Proprietor?:No
Enumeration Date:2022-05-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse