Organization
HAVASU PRIMARY CARE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANU LONIAL M.D. (PRESIDENT)
(928) 453-0777
Entity
Organization
Contact information
Practice address
1830 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5885
(928) 453-0777
(928) 453-0778
Mailing address
PO BOX 626, LAKE HAVASU CITY, AZ 86405-0626
(928) 453-0777
(928) 453-0778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
43225
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16428743
CORPORATION REGISTRATION
AZ
Enumeration date
12/10/2010
Last updated
12/10/2010
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