MEDICARE: ELIZABETH MANOGUE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	13629	CA

General Provider Information

NPI Number	:	1497754584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MANOGUE NP

Provider Business Mailing Address
First Line	:	8988 GAINSBOROUGH AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-3100
Country	:	US
Telephone Number	:	858-337-1663
Fax Number	:	858-538-1028

Provider Business Practice Location Address
First Line	:	9850 GENESEE AVE
Second Line	:	SUITE 335
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1224
Country	:	US
Telephone Number	:	858-457-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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