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Individual
MINI A MANI
Active
Individual
MINI A MANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02840
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180025201 (MDACC)
—
TX
01
—
8N6065
BCBS (MDACC)
TX
01
—
P00242889
RR MEDICARE (MDACC)
TX
Enumeration date
08/10/2006
Last updated
02/12/2019
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