Provider Demographics
NPI:1689980534
Name:MANNEY, AVON DAY
Entity Type:Individual
Prefix:DR
First Name:AVON
Middle Name:DAY
Last Name:MANNEY
Suffix:
Gender:F
Credentials:
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 2097
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-0209
Mailing Address - Country:US
Mailing Address - Phone:510-859-4196
Mailing Address - Fax:
Practice Address - Street 1:5737 THORNHILL DR STE 207B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2144
Practice Address - Country:US
Practice Address - Phone:510-859-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11349204C00000X, 204D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A11349OtherCALIFORNIA LICENSE NUMBER