Individual
HIPOLITO MANCE CUSTODIO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
945 GOETHALS DR, SUITE 200, RICHLAND, WA 99352-3552
(509) 942-2555
(509) 942-2340
Mailing address
550 GAGE BLVD, STE 101, RICHLAND, WA 99352-9532
(509) 942-3627
(509) 627-2983
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD60074660
WA
207V00000X
Obstetrics & Gynecology Physician
MT186614
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0249026
LABOR & INDUSTRIES
WA
05
—
8544694
—
WA
Enumeration date
05/15/2007
Last updated
05/10/2021
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