Provider Demographics
NPI:1417391244
Name:MANTIONE, DIEGA CAROL (DMT)
Entity type:Individual
Prefix:MS
First Name:DIEGA
Middle Name:CAROL
Last Name:MANTIONE
Suffix:
Gender:F
Credentials:DMT
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:DIEGA
Other - Last Name:MANTIONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:810 BACA ST APT F
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0950
Mailing Address - Country:US
Mailing Address - Phone:505-603-4187
Mailing Address - Fax:
Practice Address - Street 1:810 BACA ST APT F
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-0950
Practice Address - Country:US
Practice Address - Phone:505-603-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist