Provider Demographics
NPI:1467477885
Name:MANAVI, DANIEL S (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:MANAVI
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:PO BOX 260602
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0602
Mailing Address - Country:US
Mailing Address - Phone:818-990-1445
Mailing Address - Fax:818-990-1444
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:STE 820
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-990-1445
Practice Address - Fax:818-990-1444
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69875207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G69875Medicaid
CA00G698750OtherBLUE SHIELD
CAWG69875PMedicare PIN
CA00G698750OtherBLUE SHIELD