Provider Demographics
NPI:1386655389
Name:MANJUCK, JANICE E (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:MANJUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 MT DIABLO BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3717
Mailing Address - Country:US
Mailing Address - Phone:925-962-6602
Mailing Address - Fax:925-299-6849
Practice Address - Street 1:3687 MT DIABLO BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3717
Practice Address - Country:US
Practice Address - Phone:925-962-6602
Practice Address - Fax:925-299-6849
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72767207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G727670Medicaid
CA00G727670Medicaid
CA00G727672Medicare PIN
CAF18109Medicare UPIN
CA00G727673Medicare PIN
CA00G727670Medicare PIN