Provider Demographics
NPI:1295545630
Name:MANFREDO, JOSEPH KURIAN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KURIAN
Last Name:MANFREDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13113 BOX CANYON RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-6203
Mailing Address - Country:US
Mailing Address - Phone:405-219-9890
Mailing Address - Fax:
Practice Address - Street 1:13113 BOX CANYON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-6203
Practice Address - Country:US
Practice Address - Phone:405-219-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program