Provider Demographics
NPI:1053014688
Name:MANCANO, RENATA MARTINS DE BARROS (MD)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:MARTINS DE BARROS
Last Name:MANCANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 SW 75TH TER APT 209
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-5288
Mailing Address - Country:US
Mailing Address - Phone:352-278-7219
Mailing Address - Fax:352-627-4299
Practice Address - Street 1:6201 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4305
Practice Address - Country:US
Practice Address - Phone:352-265-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1883207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology