Custodio, Hipolito Mance
Custodio, Hipolito Mance is an individual health care provider with primary practice located at 945 Goethals Dr Suite 200, Richland WA 99352-3552. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Custodio, Hipolito Mance can be contacted via phone (509) 942-2555.Contact Information
Primary practice address
945 Goethals Dr Suite 200
Richland WA 99352-3552
Phone: (509) 942-2555
Fax: (509) 942-2340
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | MT186614 | Pennsylvania |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | MD60074660 | Washington |
Profile Details
| NPI number | 1225244379 |
|---|---|
| LBN Legal business name | Custodio, Hipolito Mance |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 15th, 2007 |
| Last updated | May 10th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1225244379 | NPPES |
| Washington | Other | 0249026 | LABOR & INDUSTRIES |
| Washington | MEDICAID | 8544694 | LABOR & INDUSTRIES |
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