1720472533 NPI number — EUNICE ONG MANZANO FNP-C

Table of content: DR. JARED ALAN JOHNSON MD (NPI 1750819868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720472533 NPI number — EUNICE ONG MANZANO FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANZANO
Provider First Name:
EUNICE
Provider Middle Name:
ONG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ONG
Provider Other First Name:
EUNICE
Provider Other Middle Name:
LLORENTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720472533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9300 CAMPUS POINT DR.
Provider Second Line Business Mailing Address:
MC8745
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-657-7728
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 CAMPUS POINT DR.
Provider Second Line Business Practice Location Address:
MC8745
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-7728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2015

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: 363LF0000X , with the licence number:  23841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: 23841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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