Provider Demographics
NPI:1245286889
Name:MANOS, PAUL J (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MANOS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1700 E WALNUT AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2605
Mailing Address - Country:US
Mailing Address - Phone:310-301-2030
Mailing Address - Fax:310-306-5247
Practice Address - Street 1:2400 E 4TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2026
Practice Address - Country:US
Practice Address - Phone:619-470-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7094207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A7094EMedicare PIN