Basic Information
| Provider Information | |||||||||
| NPI: | 1447320494 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MANTI ANESTHESIA PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 484 | ||||||||
| Address2: | |||||||||
| City: | MANATI | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006740484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
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| Practice Location | |||||||||
| Address1: | DOCTOR CENTER HOSPITAL | ||||||||
| Address2: | |||||||||
| City: | MANATI | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006740484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | TAVERAS | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878411949 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.