Individual
MANUEL ALFONSO DAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MHA
Contact information
Practice address
134 THURBERS AVE STE 212, PROVIDENCE, RI 02905-4721
(401) 383-5051
(401) 432-7082
Mailing address
1 MANSFIELD AVE APT B101, MANSFIELD, MA 02048-1995
(520) 612-9551
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/02/2022
Last updated
12/02/2022
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