Provider Demographics
NPI:1164782314
Name:MANAFOV, ELMAR (MS, CNIM)
Entity Type:Individual
Prefix:MR
First Name:ELMAR
Middle Name:
Last Name:MANAFOV
Suffix:
Gender:M
Credentials:MS, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 5TH ST UNIT 6C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2364
Mailing Address - Country:US
Mailing Address - Phone:214-597-7876
Mailing Address - Fax:
Practice Address - Street 1:13 S TEJON ST STE 501
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1530
Practice Address - Country:US
Practice Address - Phone:214-597-7876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic