Provider Demographics
NPI:1770866196
Name:MANZANO, FRANCES IRIS DAGUMBOY
Entity Type:Individual
Prefix:
First Name:FRANCES IRIS
Middle Name:DAGUMBOY
Last Name:MANZANO
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 1:611 STANFORD WAY APT A
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4500
Mailing Address - Country:US
Mailing Address - Phone:347-726-0042
Mailing Address - Fax:
Practice Address - Street 1:2299 ODDIE BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-7573
Practice Address - Country:US
Practice Address - Phone:775-358-4721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist