Provider Demographics
NPI:1306097035
Name:MANZI, GABRIEL HUMBERTO (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:HUMBERTO
Last Name:MANZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2040
Mailing Address - Country:US
Mailing Address - Phone:954-463-4383
Mailing Address - Fax:954-463-9820
Practice Address - Street 1:1309 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2040
Practice Address - Country:US
Practice Address - Phone:954-463-4383
Practice Address - Fax:954-463-9820
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036121223207Q00000X
WI3460207RG0300X
FLME125533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine