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MANZANITA MEDICAL PLLC NPI 1306376611


NPI Information

NPI: 1306376611
Provider Name: MANZANITA MEDICAL PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 03D2132669

Address:
4545 E SHEA BLVD STE 130
PHOENIX, AZ
ZIP 85028
Phone: (480) 292-9532
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MANZANITA MEDICAL PLLC is a family medicine in Phoenix, AZ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MANZANITA MEDICAL PLLC NPI is 1306376611. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4545 E SHEA BLVD STE 130
PHOENIX, AZ
ZIP 85028-061
Phone: (480) 292-9532
Fax: (480) 664-3482

The provider's authorized official is Judith Hallas .
The authorized official title is Office Manager and has the following contact phone number (480) 292-9532.

The CLIA number assigned to this NPI record is 03D2132669 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/19/2017 and was last updated on 4/18/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Q00000XFamily MedicineARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.