Provider Demographics
NPI:1922885938
Name:MANZANILLO, VERUSHKA
Entity Type:Individual
Prefix:
First Name:VERUSHKA
Middle Name:
Last Name:MANZANILLO
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 1:7448 LA PAZ BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6016
Mailing Address - Country:US
Mailing Address - Phone:954-675-9085
Mailing Address - Fax:
Practice Address - Street 1:7448 LA PAZ BLVD APT 206
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6016
Practice Address - Country:US
Practice Address - Phone:954-675-9085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker