Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G62860 | CA |
NPI | 1023026028 |
---|---|
Provider Name | Mr. Joseph A Manzini |
First Address | Huntington Beach, CA 92648-1346 |
Second Address | Huntington Beach, CA 92648-1346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 07/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G628601 | (05) | CA |
E17560 | (02) |