Provider Demographics
NPI:1275980310
Name:SOHAIL MANZOOR, M.D., INC
Entity Type:Organization
Organization Name:SOHAIL MANZOOR, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-981-7452
Mailing Address - Street 1:12740 HESPERIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8306
Mailing Address - Country:US
Mailing Address - Phone:760-981-7452
Mailing Address - Fax:
Practice Address - Street 1:12830 HESPERIA RD
Practice Address - Street 2:SUITE D
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7788
Practice Address - Country:US
Practice Address - Phone:760-981-7452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132832305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization