Provider Demographics
NPI:1063944767
Name:ALBERTO MANZOR, MD PA
Entity type:Organization
Organization Name:ALBERTO MANZOR, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-251-1175
Mailing Address - Street 1:701 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-1965
Mailing Address - Country:US
Mailing Address - Phone:305-823-3000
Mailing Address - Fax:305-456-0343
Practice Address - Street 1:701 E 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-1965
Practice Address - Country:US
Practice Address - Phone:305-823-3000
Practice Address - Fax:305-456-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFM722YMedicare PIN