1538418959 NPI number — DR. ERIC MANZANO PHARMD

Table of content: MARISSA ANN SMITH LAC (NPI 1619476843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538418959 NPI number — DR. ERIC MANZANO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANZANO
Provider First Name:
ERIC
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANZANO
Provider Other First Name:
VICTOR
Provider Other Middle Name:
ERIC
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1538418959
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 MAHOGANY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94080-3466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-802-6777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 METRO CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSTER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-286-0759
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  67644 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)