Provider Demographics
NPI:1134407307
Name:MANZOR, ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:MANZOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10081 PINES BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6184
Mailing Address - Country:US
Mailing Address - Phone:954-251-1175
Mailing Address - Fax:786-364-0000
Practice Address - Street 1:10081 PINES BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6184
Practice Address - Country:US
Practice Address - Phone:954-251-1175
Practice Address - Fax:786-364-0000
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109374207R00000X
FL109374282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital