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General NPI Number Information
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NPI Number | 1891938676
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Entity Type | Organization
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Legal Business Name | MANNIE JOEL MD INC.
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 15035 E 14TH ST
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1901
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Country | US
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Telephone | 510-278-0226
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Fax | 510-278-5054
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Provider Business Mailing Address
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Address Line | 15035 E 14TH ST
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City | SAN LEANDRO
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State | CA
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Zip | 94578-1901
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Country | US
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Telephone | 510-278-0226
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Fax | 510-278-5054
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SELENA M MAINARICK
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Credential |
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Telephone | 510-278-0226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | A34460
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License Number State | CA
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