Provider Demographics
NPI:1801969605
Name:MANGUAL-CASANOVA, TERESITA (MD)
Entity type:Individual
Prefix:DR
First Name:TERESITA
Middle Name:
Last Name:MANGUAL-CASANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12ST. L 13 COLINAS DE CUPEY
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-748-4223
Mailing Address - Fax:
Practice Address - Street 1:# 100 MUNOZ MARIN AVE. HIMA CAGUAS SUITE 140
Practice Address - Street 2:SUITE 140 HIMA SAN PABLO CAGUAS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-745-1314
Practice Address - Fax:787-745-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6151208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR28493Medicare ID - Type Unspecified
PRH31044Medicare UPIN