Provider Demographics
NPI:1245885342
Name:MANICA ISIGUZO, MD PA
Entity type:Organization
Organization Name:MANICA ISIGUZO, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISIGUZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-248-1207
Mailing Address - Street 1:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78297-1936
Mailing Address - Country:US
Mailing Address - Phone:830-248-1207
Mailing Address - Fax:830-331-1110
Practice Address - Street 1:34910 INTERSTATE 10 W STE 601
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9230
Practice Address - Country:US
Practice Address - Phone:830-248-1207
Practice Address - Fax:830-331-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty