Provider Demographics
NPI:1790890788
Name:MANCHEL, BRUCE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:MANCHEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:ALAN
Other - Last Name:MANCHEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1121 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3401
Mailing Address - Country:US
Mailing Address - Phone:619-435-0151
Mailing Address - Fax:619-435-9316
Practice Address - Street 1:1121 10TH ST
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3401
Practice Address - Country:US
Practice Address - Phone:619-435-0151
Practice Address - Fax:619-435-9316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2930213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC18880FOtherMEDI CAL
CAWE2930AMedicare PIN
T19253Medicare UPIN