Provider Demographics
NPI:1013429687
Name:MANUEL C PECANA MD PLLC
Entity Type:Organization
Organization Name:MANUEL C PECANA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PECANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-994-7095
Mailing Address - Street 1:1615 W ABRAM ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-1788
Mailing Address - Country:US
Mailing Address - Phone:682-238-3507
Mailing Address - Fax:682-238-3508
Practice Address - Street 1:1600 CROCKETT CIR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-6221
Practice Address - Country:US
Practice Address - Phone:817-994-7095
Practice Address - Fax:682-238-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty