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Individual

PATRICK MANZANZA DIONGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
345 SACO ST UNIT 9, WESTBROOK, ME 04092-2067
(646) 662-2619
Mailing address
345 SACO ST UNIT 9, WESTBROOK, ME 04092-2067
(646) 662-2619

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
00009
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
83-4495838
ME
Enumeration date
05/20/2019
Last updated
05/20/2019
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  • EDI platform