Provider Demographics
NPI:1306902366
Name:MARIANO, JANET MANDELL (DOM)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:MANDELL
Last Name:MARIANO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ASPEN DR
Mailing Address - Street 2:SUITE 302B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5459
Mailing Address - Country:US
Mailing Address - Phone:505-920-4725
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:SUITE 302B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5459
Practice Address - Country:US
Practice Address - Phone:505-920-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist