Provider Demographics
NPI:1649784398
Name:MANZOOR, ANEELA (FNP)
Entity type:Individual
Prefix:
First Name:ANEELA
Middle Name:
Last Name:MANZOOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9726 RAMSGATE PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-3152
Mailing Address - Country:US
Mailing Address - Phone:714-600-5072
Mailing Address - Fax:
Practice Address - Street 1:817 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3407
Practice Address - Country:US
Practice Address - Phone:951-339-8459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily