Provider Demographics
NPI:1235390410
Name:MANNASMITH, ANITA CORTEZ
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CORTEZ
Last Name:MANNASMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ISC ALAMEDA COAST GUARD ISLAND
Mailing Address - Street 2:BLDG 1 MEDICAL CLINIC
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-437-5628
Mailing Address - Fax:
Practice Address - Street 1:ISC ALAMEDA COAST GUARD ISLAND
Practice Address - Street 2:BLDG 1 MEDICAL CLINIC
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-437-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other