Healthcare Provider Details

I. General information

NPI: 1528050457
Provider Name (Legal Business Name): PAUL T MANNEY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR SUITE W-201
PALM SPRINGS CA
92262-4800
US

IV. Provider business mailing address

PO BOX 2110
PALM SPRINGS CA
92263-2110
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4511
  • Fax: 760-416-4512
Mailing address:
  • Phone: 760-778-1660
  • Fax: 760-778-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA13404
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13404
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA13404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: