Provider Demographics
NPI:1356816920
Name:MANZO, ANTHONY STEPHEN (PA-C, PARAMEDIC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:STEPHEN
Last Name:MANZO
Suffix:
Gender:M
Credentials:PA-C, PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27522 ANTONIO PKWY STE P3
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2166
Mailing Address - Country:US
Mailing Address - Phone:949-207-3786
Mailing Address - Fax:
Practice Address - Street 1:27522 ANTONIO PKWY
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2165
Practice Address - Country:US
Practice Address - Phone:949-207-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant