Provider Demographics
NPI:1023026028
Name:MANZINI, JOSEPH A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:MANZINI
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 1:18351 BEACH BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1346
Mailing Address - Country:US
Mailing Address - Phone:714-841-6529
Mailing Address - Fax:714-841-6429
Practice Address - Street 1:18351 BEACH BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1346
Practice Address - Country:US
Practice Address - Phone:714-841-6529
Practice Address - Fax:714-841-6429
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62860207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G628601Medicaid
E17560Medicare UPIN
CAG62860Medicare PIN