Provider Demographics
NPI:1912014804
Name:MANTERO ATIENZA, EMILIO (MD)
Entity Type:Individual
Prefix:MR
First Name:EMILIO
Middle Name:
Last Name:MANTERO ATIENZA
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 1:1200 ALTON RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3810
Mailing Address - Country:US
Mailing Address - Phone:305-326-0776
Mailing Address - Fax:305-326-0077
Practice Address - Street 1:1200 ALTON RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3810
Practice Address - Country:US
Practice Address - Phone:305-326-0776
Practice Address - Fax:305-326-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME619682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370803900Medicaid
FL370803900Medicaid
F40280Medicare UPIN