Provider Demographics
NPI:1386121580
Name:MANA VASCULAR CLINIC, PLLC
Entity type:Organization
Organization Name:MANA VASCULAR CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANNERY
Authorized Official - Middle Name:SIOELI
Authorized Official - Last Name:LAUVAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-979-7095
Mailing Address - Street 1:14780 W MOUNTAIN VIEW BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7280
Mailing Address - Country:US
Mailing Address - Phone:520-979-7095
Mailing Address - Fax:
Practice Address - Street 1:18555 N 79TH AVE STE B101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8372
Practice Address - Country:US
Practice Address - Phone:520-979-7095
Practice Address - Fax:623-594-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty