Provider Demographics
NPI:1184734808
Name:MANTERO, DIEGO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:MANTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 COLLINS AVE
Mailing Address - Street 2:APT 903
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2201
Mailing Address - Country:US
Mailing Address - Phone:305-868-0873
Mailing Address - Fax:
Practice Address - Street 1:3280 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7252
Practice Address - Country:US
Practice Address - Phone:305-444-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT15204OtherLICENSE #