Provider Demographics
NPI:1336476357
Name:MANZOOR, SOHAIL (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIL
Middle Name:
Last Name:MANZOOR
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 1:12740 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:760-245-9448
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:760-245-9448
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY275741207R00000X
CAA132832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine