Provider Demographics
NPI:1477894087
Name:MANTA SALUD, INC.
Entity Type:Organization
Organization Name:MANTA SALUD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOINAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-294-5551
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX
Mailing Address - Street 2:PMB 486
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-294-5551
Mailing Address - Fax:484-723-4846
Practice Address - Street 1:1883 CALLE GLASGOW
Practice Address - Street 2:COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4820
Practice Address - Country:US
Practice Address - Phone:787-294-5551
Practice Address - Fax:484-723-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization