Provider Demographics
NPI:1245794700
Name:GARCIA MANZANILLO, MARTIN RAUL II (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:RAUL
Last Name:GARCIA MANZANILLO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:210 PASEO TRIO VEGABAJENO APT 226
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-5844
Mailing Address - Country:US
Mailing Address - Phone:939-251-3233
Mailing Address - Fax:
Practice Address - Street 1:210 PASEO TRIO VEGABAJENO APT 226
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-5844
Practice Address - Country:US
Practice Address - Phone:939-251-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical