Healthcare Provider Details

I. General information

NPI: 1275855488
Provider Name (Legal Business Name): ZOLTAN NAGYMANYOKI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 S HIGUERA ST
SAN LUIS OBISPO CA
93401-7462
US

IV. Provider business mailing address

PO BOX 5007
SAN LUIS OBISPO CA
93403-5007
US

V. Phone/Fax

Practice location:
  • Phone: 805-546-0907
  • Fax:
Mailing address:
  • Phone: 805-710-7308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA129351
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberA129351
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA129351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: