Provider Demographics
NPI:1063428670
Name:MANITO-HUGO, MIRLA GUEVARRA (MD)
Entity type:Individual
Prefix:DR
First Name:MIRLA
Middle Name:GUEVARRA
Last Name:MANITO-HUGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11797 SOUTH FREEWAY
Mailing Address - Street 2:SUITE 246
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7035
Mailing Address - Country:US
Mailing Address - Phone:817-551-5539
Mailing Address - Fax:817-551-5662
Practice Address - Street 1:11797 SOUTH FREEWAY
Practice Address - Street 2:SUITE 246
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-551-5539
Practice Address - Fax:817-551-5662
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7271208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
B78358Medicare UPIN