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General NPI Number Information
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NPI Number | 1083045561
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Entity Type | Organization
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Legal Business Name | MANNY-NELSON MED LLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 1612 CENTERVILLE TURNPIKE SUITE 308
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-227-6844
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 CENTERVILLE TURNPIKE SUITE 308
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464
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Country | US
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Telephone | 757-227-6844
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Fax |
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. EMMANUEL DELA CRUZ
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Credential |
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Telephone | 757-227-6844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2013-253127-R
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License Number State | VA
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