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General NPI Number Information
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NPI Number | 1528735339
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Entity Type | Individual
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Provider Name | REY KENNETH MANZANO FNP-BC, NP-C
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Gender | Male
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 01/09/2022
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Provider Practice Location Address
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Address Line | 2555 S EAST AVE
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City | FRESNO
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State | CA
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Zip | 93706-5104
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Country | US
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Telephone | 559-499-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 2555 S EAST AVE FRESNO
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City | FRESNO
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State | CA
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Zip | 93706
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Country | US
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Telephone | 559-499-2400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95018083
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License Number State | CA
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