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General NPI Number Information
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NPI Number | 1962022681
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Entity Type | Organization
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Legal Business Name | MANZUR TELMED, LLC
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Dates
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Enumeration Date | 04/22/2020
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Last Update Date | 04/22/2020
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Provider Practice Location Address
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Address Line | 1441 KAPIOLANI BLVD STE 1114
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City | HONOLULU
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State | HI
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Zip | 96814-4406
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Country | US
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Telephone | 808-468-7604
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Fax |
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Provider Business Mailing Address
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Address Line | 5439 ITHACA AVE
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City | LAS VEGAS
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State | NV
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Zip | 89122-7143
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Country | US
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Telephone | 702-412-0466
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | JUAN MANZUR
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Credential | MD
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Telephone | 702-434-0931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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