Provider Demographics
NPI:1457639429
Name:ALVARO G MANOTAS MD PA
Entity Type:Organization
Organization Name:ALVARO G MANOTAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-474-9777
Mailing Address - Street 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-474-9777
Mailing Address - Fax:
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-474-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME407742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067467200Medicaid
FL94159Medicare PIN
FL067467200Medicaid