Provider Demographics
NPI:1194915603
Name:DANIEL V MANZANARES, MD, PLLC
Entity type:Organization
Organization Name:DANIEL V MANZANARES, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:MANZANARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-866-5070
Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4700
Mailing Address - Country:US
Mailing Address - Phone:602-866-5070
Mailing Address - Fax:
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4700
Practice Address - Country:US
Practice Address - Phone:602-866-5070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL V MANZANARES, MD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71116Medicare PIN
AZG36405Medicare UPIN