Provider Demographics
NPI:1639358898
Name:MANDANAS, RIZALINO MONTENEGRO (MD)
Entity Type:Individual
Prefix:DR
First Name:RIZALINO
Middle Name:MONTENEGRO
Last Name:MANDANAS
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 1:2824 CHATSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1804
Mailing Address - Country:US
Mailing Address - Phone:803-788-6846
Mailing Address - Fax:803-788-6846
Practice Address - Street 1:2824 CHATSWORTH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1804
Practice Address - Country:US
Practice Address - Phone:803-788-6846
Practice Address - Fax:803-788-6846
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine