Basic Information
| Provider Information | |||||||||
| NPI: | 1730814658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALMANZAR | ||||||||
| FirstName: | MIRTHA | ||||||||
| MiddleName: | CAMILA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1793 RIVERSIDE DR APT 1C | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100345336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6463717535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2022 | ||||||||
| LastUpdateDate: | 07/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | RD4766572 | 01 | PASSPORT | OTHER | 40224015889 | 01 | ID DOMINICAN REPUBLIC | OTHER |