Basic Information
| Provider Information | |||||||||
| NPI: | 1629796461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANZANO RODRIGUEZ | ||||||||
| FirstName: | LILA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4756 | ||||||||
| Address2: | |||||||||
| City: | AGUADILLA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006054756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874042838 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 550S CALLE CONCEPCION VERA AYALA | ||||||||
| Address2: | CARR 110 KM 12.2 | ||||||||
| City: | MOCA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006765005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878778000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2022 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 22958 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.