Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 20A11349 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A11349 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A11349 | CA |
NPI | 1689980534 |
---|---|
Provider Name | Dr. Avon Day Manney |
First Address | Dublin, CA 94568-0209 |
Second Address | Oakland, CA 94611-2144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2010 |
Last Update Date | 14/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A11349 | CALIFORNIA LICENSE NUMBER (01) | CA |