Provider Demographics
NPI:1053596544
Name:MANTES, RUENA ANN BERNARDINO
Entity type:Individual
Prefix:MISS
First Name:RUENA ANN
Middle Name:BERNARDINO
Last Name:MANTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 E. 220TH STREET
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2442
Mailing Address - Country:US
Mailing Address - Phone:805-844-4152
Mailing Address - Fax:
Practice Address - Street 1:1000 W. CARSON STREET
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509-2910
Practice Address - Country:US
Practice Address - Phone:310-222-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program