Provider Demographics
NPI:1902083926
Name:MANOLO P MAPA
Entity Type:Organization
Organization Name:MANOLO P MAPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MANOLO
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-385-5297
Mailing Address - Street 1:129 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-4531
Mailing Address - Country:US
Mailing Address - Phone:330-385-5297
Mailing Address - Fax:330-385-2540
Practice Address - Street 1:129 W 4TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-4531
Practice Address - Country:US
Practice Address - Phone:330-385-5297
Practice Address - Fax:330-385-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30537203305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0254362Medicaid
OH0254362Medicaid