Provider Demographics
NPI:1437263936
Name:MANGUAL, AMARILYS (MD)
Entity Type:Individual
Prefix:DR
First Name:AMARILYS
Middle Name:
Last Name:MANGUAL
Suffix:
Gender:F
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:URB. LA GUADALUPE
Mailing Address - Street 2:AVE. JARDINES PONCIANA 1710
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-856-1000
Mailing Address - Fax:
Practice Address - Street 1:COMERCIO STREET # 61
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-0844
Practice Address - Fax:787-267-8777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11904207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41218Medicare UPIN