Provider Demographics
NPI:1548274335
Name:PUIG, MANUEL ANTONIO (PAC)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:PUIG
Suffix:
Gender:M
Credentials:PAC
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Other - First Name:
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Mailing Address - Street 1:RR 26 BOX 6766-49
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2582
Mailing Address - Country:US
Mailing Address - Phone:956-424-9863
Mailing Address - Fax:956-424-9868
Practice Address - Street 1:RR 26 BOX 6766-49
Practice Address - Street 2:RR 26 BOX 6766-49 STE# B
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2582
Practice Address - Country:US
Practice Address - Phone:956-424-9863
Practice Address - Fax:956-424-9868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical