Provider Demographics
NPI:1710278932
Name:MUNICIPIO DE MANATI
Entity Type:Organization
Organization Name:MUNICIPIO DE MANATI
Other - Org Name:MANATI PRIMARY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONET
Authorized Official - Suffix:
Authorized Official - Credentials:MBA/HCM
Authorized Official - Phone:787-854-2292
Mailing Address - Street 1:10 QUINONEZ ST
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-2292
Mailing Address - Fax:787-854-2092
Practice Address - Street 1:ROAD #2 KM. 50.0
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-2292
Practice Address - Fax:787-854-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83560Medicare UPIN