Provider Demographics
NPI:1720472533
Name:MANZANO, EUNICE ONG (FNP-C)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:ONG
Last Name:MANZANO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:EUNICE
Other - Middle Name:LLORENTE
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:9300 CAMPUS POINT DR.
Mailing Address - Street 2:MC8745
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-657-7728
Mailing Address - Fax:
Practice Address - Street 1:9300 CAMPUS POINT DR.
Practice Address - Street 2:MC8745
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-657-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23841363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics