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General NPI Number Information
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NPI Number | 1649205329
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Entity Type | Individual
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Provider Name | BRUCE MANZIELLO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NORTHERN ARIZONA VA HEALTH CARE SYSTEM 5000 N. HIGHWAY 89
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City | PRESCOTT
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State | AZ
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Zip | 86313
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Country | US
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Telephone | 928-445-4860
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Fax | 928-776-6084
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Provider Business Mailing Address
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Address Line | PO BOX 150
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City | PRESCOTT
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State | AZ
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Zip | 86302-0150
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Country | US
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Telephone | 928-445-4860
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Fax | 928-776-6084
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 127042
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License Number State | NY
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