Healthcare Provider Details

I. General information

NPI: 1306097035
Provider Name (Legal Business Name): GABRIEL HUMBERTO MANZI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2040
US

IV. Provider business mailing address

1309 S FEDERAL HWY
FORT LAUDERDALE FL
33316-2040
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-4383
  • Fax: 954-463-9820
Mailing address:
  • Phone: 954-463-4383
  • Fax: 954-463-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036121223
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number3460
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME125533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: