Provider Demographics
NPI:1285799197
Name:MANZANARES, DANIEL V (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:V
Last Name:MANZANARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:V
Other - Last Name:MANZANARES, MD, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:602-866-5070
Mailing Address - Fax:602-866-5093
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:602-866-5093
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ71116Medicare PIN
AZG36405Medicare UPIN