Individual
ALEJANDRA DECANINI MANCERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12000 ELM CREEK BLVD N STE 100, MAPLE GROVE, MN 55369-7074
(763) 416-7600
(763) 416-7634
Mailing address
8401 GOLDEN VALLEY RD STE 330, GOLDEN VALLEY, MN 55427-4687
(763) 416-7600
(763) 416-7634
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
55595
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20375
RESIDENT PERMIT
MN
Enumeration date
05/07/2008
Last updated
08/03/2023
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