Provider Demographics
NPI:1578529624
Name:MANZANERO, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:MANZANERO
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 1:88 PIIKOI ST
Mailing Address - Street 2:APT. 2807
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4245
Mailing Address - Country:US
Mailing Address - Phone:808-284-7733
Mailing Address - Fax:
Practice Address - Street 1:88 PIIKOI ST
Practice Address - Street 2:APT. 2807
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4245
Practice Address - Country:US
Practice Address - Phone:808-284-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD119762085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI52174101Medicaid
HI54816Medicare ID - Type Unspecified
HI52174101Medicaid