Provider Demographics
NPI:1366966756
Name:MANZANO MORA, FANI R
Entity type:Individual
Prefix:
First Name:FANI
Middle Name:R
Last Name:MANZANO MORA
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 1:560 NW 7TH ST APT 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3215
Mailing Address - Country:US
Mailing Address - Phone:786-678-3897
Mailing Address - Fax:
Practice Address - Street 1:1621 SW 126TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-1433
Practice Address - Country:US
Practice Address - Phone:786-678-3897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician