| Mana Vascular Clinic, Pllc | |
|
18555 N 79th Ave Ste B101 Glendale AZ 85308-8372 | |
| (520) 979-7095 | |
| (623) 594-2252 |
| Full Name | Mana Vascular Clinic, Pllc |
|---|---|
| Speciality | Surgery |
| Location | 18555 N 79th Ave Ste B101, Glendale, Arizona |
| Authorized Official Name and Position | Lannery Sioeli Lauvao (OWNER) |
| Authorized Official Contact | 5209797095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mana Vascular Clinic, Pllc 14780 W Mountain View Blvd Ste 120 Surprise AZ 85374-7280 Ph: (520) 979-7095 | Mana Vascular Clinic, Pllc 18555 N 79th Ave Ste B101 Glendale AZ 85308-8372 Ph: (520) 979-7095 |
| NPI Number | 1386121580 |
|---|---|
| Provider Enumeration Date | 07/20/2018 |
| Last Update Date | 08/11/2024 |
| Medicare PECOS PAC ID | 3577817931 |
|---|---|
| Medicare Enrollment ID | O20181121001494 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386121580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | (* (Not Available)) | Primary |
| Provider Name | Lannery S Lauvao |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1124242029 PECOS PAC ID: 5395899264 Enrollment ID: I20090812000701 |
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