Provider Demographics
NPI:1386028553
Name:CANO RIVERA, MANUEL ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ROBERTO
Last Name:CANO RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 S ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1751
Mailing Address - Country:US
Mailing Address - Phone:361-855-7346
Mailing Address - Fax:
Practice Address - Street 1:3435 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-855-7346
Practice Address - Fax:361-855-7579
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5707208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics