Provider Demographics
NPI:1669579207
Name:MANZONE, DOMENICO J (MD)
Entity type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:J
Last Name:MANZONE
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 1:320 DARDANELLI LN
Mailing Address - Street 2:SUITE 23 B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1440
Mailing Address - Country:US
Mailing Address - Phone:408-866-2500
Mailing Address - Fax:408-866-2469
Practice Address - Street 1:320 DARDANELLI LN
Practice Address - Street 2:SUITE 23 B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1440
Practice Address - Country:US
Practice Address - Phone:408-866-2500
Practice Address - Fax:408-866-2469
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25650208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24521Medicare UPIN
CA256500Medicare PIN