Healthcare Provider Details

I. General information

NPI: 1356523633
Provider Name (Legal Business Name): ALEX JESUS MANZANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 620
MIAMI BEACH FL
33140-2876
US

IV. Provider business mailing address

7887 N KENDALL DR STE 215
MIAMI FL
33156-7758
US

V. Phone/Fax

Practice location:
  • Phone: 786-433-2450
  • Fax: 305-413-5934
Mailing address:
  • Phone: 786-433-2450
  • Fax: 786-607-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME110062
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME110062
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: