Provider Demographics
NPI:1407522311
Name:MANZON, JOHN VINCENT MANZON
Entity Type:Individual
Prefix:
First Name:JOHN VINCENT
Middle Name:MANZON
Last Name:MANZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 1/2 ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3827
Mailing Address - Country:US
Mailing Address - Phone:310-293-8535
Mailing Address - Fax:
Practice Address - Street 1:1263 1/2 ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3827
Practice Address - Country:US
Practice Address - Phone:310-293-8535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95228623163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse