Provider Demographics
NPI:1063415230
Name:MANANA, ANGELA
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MANANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0858
Mailing Address - Country:US
Mailing Address - Phone:787-854-6066
Mailing Address - Fax:787-884-7217
Practice Address - Street 1:MANATI MEDICAL CENTER DR. OTERO LOPEZ SUITE 105
Practice Address - Street 2:URB. ATENAS CALLE HERNANDEZ CARRION
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-6066
Practice Address - Fax:787-884-7217
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4168111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1324OtherPREFERRED MEDICARE CHOICE
PR25607OtherTRIPLE-SSS
PR0025607Medicare ID - Type Unspecified
PR1324OtherPREFERRED MEDICARE CHOICE