MEDICARE: DR. BRIAN MICHAEL MANJARRES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A100304	CA

General Provider Information

NPI Number	:	1023218203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN MICHAEL MANJARRES M.D.

Provider Business Mailing Address
First Line	:	2615 LINCOLN AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-2817
Country	:	US
Telephone Number	:	760-321-1315
Fax Number	:	760-321-1094

Provider Business Practice Location Address
First Line	:	36101 BOB HOPE DR
Second Line	:	STE B-2
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2001
Country	:	US
Telephone Number	:	760-321-1315
Fax Number	:	760-321-1094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	02/21/2013

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