Provider Demographics
NPI:1275960825
Name:MANZO-MICOLETTI, ZACHARY DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DANIEL
Last Name:MANZO-MICOLETTI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 N ZARAGOZA RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7906
Mailing Address - Country:US
Mailing Address - Phone:915-857-4559
Mailing Address - Fax:
Practice Address - Street 1:1523 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7906
Practice Address - Country:US
Practice Address - Phone:915-857-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA10978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant