Provider Demographics
NPI:1962690230
Name:MANUEL MARCANO RIVERA
Entity type:Organization
Organization Name:MANUEL MARCANO RIVERA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARCANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-878-6291
Mailing Address - Street 1:115 CALLE CRISTOBAL COLON
Mailing Address - Street 2:PO BOX 4035 SUITE 457
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4740
Mailing Address - Country:US
Mailing Address - Phone:787-878-6291
Mailing Address - Fax:787-880-7733
Practice Address - Street 1:115 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4740
Practice Address - Country:US
Practice Address - Phone:787-878-6291
Practice Address - Fax:787-880-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB2953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport