Provider Demographics
NPI:1316038714
Name:EMILIO MANTERO-ATIENZA MD PA
Entity Type:Organization
Organization Name:EMILIO MANTERO-ATIENZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTERO ATIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-326-0776
Mailing Address - Street 1:1200 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3810
Mailing Address - Country:US
Mailing Address - Phone:305-326-0776
Mailing Address - Fax:305-326-0077
Practice Address - Street 1:1200 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3810
Practice Address - Country:US
Practice Address - Phone:305-326-0776
Practice Address - Fax:305-326-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254628100Medicaid
FLK0273Medicare PIN