Provider Demographics
NPI:1609558345
Name:ROSARIO MANZANO, MANUEL ENRIQUE (PA)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:ROSARIO MANZANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1143
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1143
Mailing Address - Country:US
Mailing Address - Phone:787-589-0003
Mailing Address - Fax:787-868-1752
Practice Address - Street 1:417 KM 0.7 BO. ASOMANTE
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-589-0003
Practice Address - Fax:787-868-1752
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPA475363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty