Provider Demographics
NPI:1710566484
Name:MANZANO, ROXAN JUNA LEE SIMON (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROXAN JUNA LEE
Middle Name:SIMON
Last Name:MANZANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ROXAN JUNA LEE
Other - Middle Name:SIMON
Other - Last Name:UMAYAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:94-530 KOALEO ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1634
Mailing Address - Country:US
Mailing Address - Phone:808-352-2652
Mailing Address - Fax:808-517-4251
Practice Address - Street 1:94-530 KOALEO ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1634
Practice Address - Country:US
Practice Address - Phone:808-352-2652
Practice Address - Fax:808-517-4251
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI79319163WW0000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WW0000XNursing Service ProvidersRegistered NurseWound Care