Provider Demographics
NPI:1215185517
Name:MANTI PARCIAL
Entity Type:Organization
Organization Name:MANTI PARCIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-739-5555
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1400
Mailing Address - Country:US
Mailing Address - Phone:787-739-5555
Mailing Address - Fax:787-739-0039
Practice Address - Street 1:CARR 2 KM46.1 BO. CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-0001
Practice Address - Fax:787-854-0030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST HOSPITAL PANAMERICANO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97CNC NUM91173261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404004Medicare UPIN