Provider Demographics
NPI:1699077388
Name:MANUEL, MONA LISA
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:LISA
Last Name:MANUEL
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 1:5055 W HACIENDA AVE
Mailing Address - Street 2:1135
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-0323
Mailing Address - Country:US
Mailing Address - Phone:702-442-0483
Mailing Address - Fax:
Practice Address - Street 1:5055 W HACIENDA AVE
Practice Address - Street 2:1135
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-0323
Practice Address - Country:US
Practice Address - Phone:702-442-0483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner