Provider Demographics
NPI:1881788651
Name:MANGUIAT, EMERLITA QUIJANO (MD)
Entity type:Individual
Prefix:DR
First Name:EMERLITA
Middle Name:QUIJANO
Last Name:MANGUIAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 S 23RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4830
Mailing Address - Country:US
Mailing Address - Phone:772-466-2045
Mailing Address - Fax:772-466-8646
Practice Address - Street 1:1801 S 23RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4830
Practice Address - Country:US
Practice Address - Phone:772-466-2045
Practice Address - Fax:772-466-8646
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME101264208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000366600Medicaid
FL003471100Medicaid
FL003471100Medicaid